浏览全部资源
扫码关注微信
托法替布联合羟氯喹治疗难治性类风湿关节炎的临床观察
Clinical observation of tofacitinib combined with hydroxychloroquine in the treatment of refractory rheumatoid arthritis
- 中国药房 2024年35卷第6期 页码：729-733
- 作者机构：
1.衡水市人民医院风湿免疫科，河北 衡水 053000
2.河北医科大学临床学院，石家庄 050017
3.衡水市人民医院全科医学科，河北 衡水 053000
- 作者简介：
主治医师。研究方向：难治性类风湿关节炎。E-mail：wangmingjie202307@163.com
主任医师，硕士。研究方向：中西医结合治疗类风湿关节炎。E-mail：xufengjin2008@sina.com
- 基金信息：河北省科技计划项目(2022HBKJ00033);衡水市科技计划项目(2020014069Z)
DOI：10.6039/j.issn.1001-0408.2024.06.16
中图分类号： R979.5;R453纸质出版日期：2024-03-30，
收稿日期：2023-09-23，
修回日期：2024-02-28，
扫 描 看 全 文
王明杰,徐风金,张艳等.托法替布联合羟氯喹治疗难治性类风湿关节炎的临床观察 Δ[J].中国药房,2024,35(06):729-733.
WANG Mingjie,XU Fengjin,ZHANG Yan,et al.Clinical observation of tofacitinib combined with hydroxychloroquine in the treatment of refractory rheumatoid arthritis[J].ZHONGGUO YAOFANG,2024,35(06):729-733.
王明杰,徐风金,张艳等.托法替布联合羟氯喹治疗难治性类风湿关节炎的临床观察 Δ[J].中国药房,2024,35(06):729-733. DOI： 10.6039/j.issn.1001-0408.2024.06.16.
WANG Mingjie,XU Fengjin,ZHANG Yan,et al.Clinical observation of tofacitinib combined with hydroxychloroquine in the treatment of refractory rheumatoid arthritis[J].ZHONGGUO YAOFANG,2024,35(06):729-733. DOI： 10.6039/j.issn.1001-0408.2024.06.16.
摘要
目的
2
观察托法替布联合羟氯喹治疗难治性类风湿关节炎（RA）的临床疗效和安全性。
方法
2
选取2021年1月1日至2022年1月1日衡水市人民医院风湿免疫科收治的难治性RA患者120例，按照简单随机分配方法分为A组、B组和C组，每组40例。A组患者给予枸橼酸托法替布片+硫酸羟氯喹片，B组患者给予枸橼酸托法替布片+甲氨蝶呤片，C组患者给予枸橼酸托法替布片+来氟米特片，3组患者均连续用药6个月。观察3组患者的疗效，治疗前后的疾病活动度评分28（DAS28）、Sharp评分和生化指标[红细胞沉降率（ESR）、C-反应蛋白（CRP）]、免疫指标[类风湿因子（RF）、抗环瓜氨酸多肽（CCP）抗体]、血清细胞因子指标[白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）]水平，记录治疗期间的不良反应发生情况。
结果
2
治疗后，A组ACR50、ACR70患者比例均显著高于B、C组（
P
＜0.05），3组患者的DAS28评分、Sharp评分以及生化、免疫、血清细胞因子指标均显著低于同组治疗前（
P
＜0.05），且随治疗时间延长逐渐降低；A组患者治疗6个月时的DAS28评分、Sharp评分、RF、抗CCP抗体、IL-6、TNF-α水平均显著低于B、C组（
P
＜0.05）。3组患者的腹泻、恶心呕吐、白细胞减少、皮疹、肝肾功能异常及头晕发生率比较，差异均无统计学意义（
P
＞0.05）。
结论
2
托法替布联合羟氯喹治疗难治性RA的疗效和安全性均较好。
Abstract
OBJECTIVE
2
To observe the clinical efficacy and safety of tofacitinib combined with hydroxychloroquine in the treatment of refractory rheumatoid arthritis （RA）.
METHODS
2
From January 1， 2021 to January 1， 2022， 120 patients with refractory RA were selected as the study objects. According to the principle of random allocation， the patients were divided into group A， group B and group C， with 40 patients in each group. Group A was given Tofacitinib citrate tablet + Hydroxychloroquine sulfate tablet； group B was given Tofacitinib citrate tablet + Methotrexate tablet； group C was given Tofacitinib citrate tablet + Leflunomide tablet. Three groups were given relevant medicine for 6 months. Therapeutic efficacy and disease activity score 28 （DAS 28） of 3 groups as well as Sharp score， the levels of biochemical indicators [erythrocyte sedimentation rate （ESR）， C-reactive protein （CRP）]， immune indexes [rheumatoid factor （RF）， anti-cyclic peptide containing citrulline （anti-CCP） antibody]， serum cytokine indicators [interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α）] before and after treatment were observed； the occurrence of adverse drug reactions during treatment was recorded.
RESULTS
2
After treatment， the proportions of ACR50 and ACR70 patients in group A were significantly higher than groups B and C （
P
＜0.05）； DAS28 score， Sharp score， biochemical indicators， immune indexes and serum cytokine indicators of 3 groups were significantly lower than before treatment （
P
＜0.05）， and gradually decreased with prolonged treatment time； after 6 months of treatment， DAS28 score， Sharp score， RF， anti-CCP antibody， the levels of IL-6 and TNF-α in group A were significantly lower than group B and C （
P
＜0.05）. There was no significant difference in the incidence of diarrhea， nausea and vomiting， leukopenia， rash， abnormal liver and kidney function， or dizziness among 3 groups （
P
＞0.05）.
CONCLUSIONS
2
Tofacitinib combined with hydroxychloroquine shows good efficacy and safety for refractory RA.
关键词
难治性类风湿关节炎托法替布羟氯喹疗效安全性
Keywords
tofacitinibhydroxychloroquineefficacysafety
references
RADU A F，BUNGAU S G. Management of rheumatoid arthritis：an overview[J]. Cells，2021，10（11）：2857.
HUANG J，FU X K，CHEN X X，et al. Promising therapeutic targets for treatment of rheumatoid arthritis[J]. Front Immunol，2021，12：686155.
DAI Y J，WANG W N，YU Y K，et al. Rheumatoid arthritis-associated interstitial lung disease：an overview of epidemiology，pathogenesis and management[J]. Clin Rheumatol，2021，40（4）：1211-1220.
BUCH M H，EYRE S，MCGONAGLE D. Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis[J]. Nat Rev Rheumatol，2021，17（1）：17-33.
GUADAGNIN D A，MAZZALI L V，SKARE T L，et al. Treating rheumatoid arthritis with leflunomide monotherapy versus combination therapy with methotrexate[J]. Eur J Rheumatol，2021，8（1）：12-15.
BARBULESCU A，ASKLING J，CHATZIDIONYSIOU K，et al. Effectiveness of baricitinib and tofacitinib compared with bDMARDs in RA：results from a cohort study using nationwide Swedish register data[J]. Rheumatology，2022，61（10）：3952-3962.
BERTOLDI I，CAPORALI R. Tofacitinib：real-world data and treatment persistence in rheumatoid arthritis[J]. Open Access Rheumatol，2021，13：221-237.
SCHREZENMEIER E，DÖRNER T. Mechanisms of action of hydroxychloroquine and chloroquine：implications for rheumatology[J]. Nat Rev Rheumatol，2020，16（3）：155-166.
VARMA V R，DESAI R J，NAVAKKODE S，et al. Hydroxychloroquine lowers Alzheimer’s disease and related dementias risk and rescues molecular phenotypes related to Alzheimer’s disease[J]. Mol Psychiatry，2023，28（3）：1312-1326.
LYU X，ZENG L Z，ZHANG H，et al. Hydroxychloroquine suppresses lung tumorigenesis via inducing FoxO3a nuclear translocation through STAT3 inactivation[J]. Life Sci，2020，246：117366.
BAI W，YANG F，XU H J，et al. A multi-center，open-label，randomized study to explore efficacy and safety of baricitinib in active primary Sjogren’s syndrome patients[J]. Trials，2023，24（1）：112.
WASSERMAN A M. Diagnosis and management of rheumatoid arthritis[J]. Am Fam Physician，2011，84（11）：1245-1252.
BUCH M H. Defining refractory rheumatoid arthritis[J]. Ann Rheum Dis，2018，77（7）：966-969.
TAYLOR P C，KEYSTONE E C，VAN DER HEIJDE D，et al. Baricitinib versus placebo or adalimumab in rheumatoid arthritis[J]. N Engl J Med，2017，376（7）：652-662.
TAKANASHI S，KANEKO Y，TAKEUCHI T. CDAI and DAS28 in the management of rheumatoid arthritis in clinical practice[J]. Ann Rheum Dis，2020，79（5）：671-674.
MEKIC M，HADZIGRAHIC E，DZUBUR A. Relation between anti-CCP antibodies and sharp score in rheumatoid arthritis[J]. Mater Sociomed，2020，32（3）：172-176.
DING Q，HU W，WANG R，et al. Signaling pathways in rheumatoid arthritis：implications for targeted therapy[J]. Signal Transduct Target Ther，2023，8（1）：68.
MELVILLE A R，KEARSLEY-FLEET L，BUCH M H，et al. Understanding refractory rheumatoid arthritis：implications for a therapeutic approach[J]. Drugs，2020，80（9）：849-857.
WAN R H，FAN Y H，ZHAO A L，et al. Comparison of efficacy of acupuncture-related therapy in the treatment of rheumatoid arthritis：a network meta-analysis of rando-mized controlled trials[J]. Front Immunol，2022，13：829409.
蒋总，姚晓玲，唐芳，等. JAK抑制剂托法替布治疗类风湿关节炎相关间质性肺病的实验研究[J]. 安徽医科大学学报，2023，58（5）：819-823.
JIANG Z，YAO X L，TANG F，et al. Experimental study on the treatment of rheumatoid arthritis associated inter-stitial pulmonary disease with JAK inhibitor tofacitinib[J]. Acta Univ Med Anhui，2023，58（5）：819-823.
HODGE J A，KAWABATA T T，KRISHNASWAMI S，et al. The mechanism of action of tofacitinib：an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis[J]. Clin Exp Rheumatol，2016，34（2）：318-328.
DAMSKY W，WANG A，KIM D J，et al. Inhibition of type 1 immunity with tofacitinib is associated with marked improvement in longstanding sarcoidosis[J]. Nat Commun，2022，13（1）：3140.
FLEISCHMANN R，KREMER J，TANAKA Y，et al. Efficacy and safety of tofacitinib in patients with active rheumatoid arthritis：review of key phase 2 studies[J]. Int J Rheum Dis，2016，19（12）：1216-1225.
0
浏览量
4
下载量
0
CSCD
- 网络PDF下载
- WORD下载
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 地址：重庆市渝中区大坪正街129号四环大厦8层 400042
- 技术支持由北京北大方正电子有限公司提供 渝ICP备15012710号
公网安备50010302001817 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies