TNF抑制剂、IL6抑制剂和甲氨蝶呤治疗免疫检查点抑制剂相关性关节炎的安全和有效性比较。
Comparative safety and effectiveness of TNF inhibitors, IL6 inhibitors and methotrexate for the treatment of immune checkpoint inhibitor-associated arthritis.
发表日期：2023 Apr 05
作者：
Anne R Bass, Noha Abdel-Wahab, Pankti D Reid, Jeffrey A Sparks, Cassandra Calabrese, Deanna P Jannat-Khah, Nilasha Ghosh, Divya Rajesh, Carlos Andres Aude, Lydia Gedmintas, Lindsey MacFarlane, Senada Arabelovic, Adewunmi Falohun, Komal Mushtaq, Farah Al Haj, Adi Diab, Ami A Shah, Clifton O Bingham, Karmela Kim Chan, Laura C Cappelli
来源：
ANNALS OF THE RHEUMATIC DISEASES
摘要：
为比较生物制剂和传统疾病修饰性抗风湿药物（DMARD）的安全性和有效性，用于免疫检查点抑制剂相关炎症性关节炎（ICI-IA）。这项回顾性的多中心观察性研究包括接受肿瘤坏死因子抑制剂（TNFi）、白细胞介素-6受体抑制剂（IL6Ri）和/或甲氨蝶呤（MTX）治疗的ICI-IA诊断患者；排除了先前存在自体免疫性疾病的患者。主要结局是ICI开始后肿瘤进展的时间；次要结局是DMARD开始后关节炎控制的时间。使用Cox比例风险模型比较药物组，调整混杂因素。共纳入147名患者（平均年龄60.3（SD 11.9）岁，66（45％）女性）。ICI-IA治疗中，33例（22％）为TNFi，42例（29％）为IL6Ri，72例（49％）为MTX。在ICI开始后到DMARD开始的时间调整后，与MTX相比，TNFi的肿瘤进展时间显著缩短（HR 3.27（95％CI 1.21到8.84，p = 0.019）），而IL6Ri的结果为HR 2.37（95％CI 0.94到5.98，p = 0.055）。与MTX相比，TNFi的关节炎控制时间更快（HR 1.91（95％CI 1.06到3.45，p = 0.032）），而IL6Ri的结果为HR 1.66（95％CI 0.93到2.97，p = 0.089）。在黑色素瘤患者的子集分析中，癌症进展和关节炎控制的结果相似。用生物制剂DMARD治疗ICI-IA与MTX相比，关节炎控制更快，但可能与肿瘤进展的时间缩短相关。©作者（或其雇主）2023年。不得进行商业再利用。查看权利和权限。由BMJ出版。
To compare the safety and effectiveness of biologic and conventional disease-modifying antirheumatic drugs (DMARDs) for immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA).The retrospective multicentre observational study included patients with a diagnosis of ICI-IA treated with a tumour necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL6Ri) and/or methotrexate (MTX); patients with pre-existing autoimmune disease were excluded. The primary outcome was time to cancer progression from ICI initiation; the secondary outcome was time to arthritis control from DMARD initiation. Cox proportional hazard models were used to compare medication groups, adjusting for confounders.147 patients were included (mean age 60.3 (SD 11.9) years, 66 (45%) women). ICI-IA treatment was TNFi in 33 (22%), IL6Ri 42 (29%) and MTX 72 (49%). After adjustment for time from ICI initiation to DMARD initiation, time to cancer progression was significantly shorter for TNFi compared with MTX (HR 3.27 (95% CI 1.21 to 8.84, p=0.019)) while the result for IL6Ri was HR 2.37 (95% CI 0.94 to 5.98, p=0.055). Time to arthritis control was faster for TNFi compared with MTX (HR 1.91 (95% CI 1.06 to 3.45, p=0.032)) while the result for IL6Ri was HR 1.66 (95% CI 0.93 to 2.97, p=0.089). A subset analysis in patients with melanoma gave similar results for both cancer progression and arthritis control.The treatment of ICI-IA with a biologic DMARD is associated with more rapid arthritis control than with MTX, but may be associated with a shorter time to cancer progression.© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.