调查强直性脊柱炎 (AS) 患者因原因停止长期使用抗肿瘤坏死因子 (TNF) 药物的相关因素。2004 年至 2018 年间开始一线抗 TNF 治疗并继续治疗的 AS 患者治疗至少两年的患者被纳入该研究。对入组患者进行观察直至最后一次就诊、停止治疗或 2022 年 9 月。停止一线抗 TNF 药物的原因分为以下几类：(1) 临床缓解，(2) 疗效丧失，(3 ) 不良事件，以及 (4) 其他原因，包括失访、费用或报销问题。使用累积发生率函数曲线来可视化每个特定原因随时间的累积故障率。利用单变量和多变量特定原因危险模型来确定与特定原因停用一线抗 TNF 药物相关的因素。该研究总共纳入了 429 名 AS 患者，其中 121 名接受阿达木单抗 (ADA) 治疗，依那西普 (ETN) 治疗有 176 例，英夫利昔单抗 (INF) 治疗有 89 例，戈利木单抗 (GLM) 治疗有 43 例。一线抗 TNF 药物的中位总生存期为 10.6 (7.9-14.5) 年。患者中，103 例（24.0%）停止治疗，其中 36 例（34.9%）由于无效，31 例（30.1%）由于临床缓解，15 例（14.6%）由于不良事件，21 例（20.4%）由于不良事件。其他原因。与接受 ADA 治疗的患者相比，接受 ETN 治疗的患者因临床缓解而停药的风险较低（风险比 [HR] 0.45 [0.21-0.99]，P = 0.048）。与 ADA 使用（HR 4.53 [1.45-14.16]，HR 4.53 [1.45-14.16]， P = 0.009）。年龄较大与感染相关不良事件导致停药的风险增加有关（HR 1.07 [1.02-1.12]，P = 0.005），当前吸烟是由于其他原因导致停药的危险因素（HR 6.22 [1.82- 21.28]，P = 0.004）。首次接受抗 TNF 治疗至少两年的 AS 患者表现出良好的长期治疗保留率，在 10.6 年的总生存期内，停药率为 24.0%。停药的预测因素因原因而异，强调了治疗反应的复杂性和个性化治疗管理方法的重要性。© 2024。作者。

To investigate the factors associated with cause-specific discontinuation of long-term anti-tumor necrosis factor (TNF) agent use in patients with ankylosing spondylitis (AS).AS patients who initiated first-line anti-TNF treatment between 2004 and 2018 and continued treatment for at least two years were enrolled in the study. Enrolled patients were observed until the last visit, discontinuation of treatment, or September 2022. Reasons for discontinuation of the first-line anti-TNF agent were categorized into the following: (1) clinical remission, (2) loss of efficacy, (3) adverse events, and (4) other reasons including loss to follow-up, cost, or reimbursement issues. A cumulative incidence function curve was used to visualize the cumulative failure rates over time for each specific reason. Univariable and multivariable cause-specific hazard models were utilized to identify factors associated with cause-specific discontinuation of the first-line anti-TNF agent.A total of 429 AS patients was included in the study, with 121 treated with adalimumab (ADA), 176 with etanercept (ETN), 89 with infliximab (INF), and 43 with golimumab (GLM). The median overall survival on the first-line anti-TNF agent was 10.6 (7.9-14.5) years. Among the patients, 103 (24.0%) discontinued treatment, with 36 (34.9%) due to inefficacy, 31 (30.1%) due to clinical remission, 15 (14.6%) due to adverse events, and 21 (20.4%) due to other reasons. Patients treated with ETN had a lower risk of discontinuation due to clinical remission compared to those receiving ADA (hazard ratio [HR] 0.45 [0.21-0.99], P = 0.048). Higher baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; HR 1.31 [1.04-1.65], P = 0.023) and INF use were linked to a higher risk of treatment discontinuation for inefficacy compared to ADA use (HR 4.53 [1.45-14.16], P = 0.009). Older age was related to an increased risk of discontinuation due to infection-related adverse events (HR 1.07 [1.02-1.12], P = 0.005), and current smoking was a risk factor for discontinuation due to other reasons (HR 6.22 [1.82-21.28], P = 0.004).AS patients on their first anti-TNF treatment for at least two years demonstrated a favorable long-term treatment retention rate, with a 24.0% discontinuation rate over a 10.6-year overall survival period. The predictors for discontinuation varied by causes, underscoring the complexity of treatment response and the importance of personalized approaches to treatment management.© 2024. The Author(s).