摘要
目的探索一种经济、有效、安全的强直性脊柱炎(AS)患者应用重组人肿瘤坏死因子Ⅱ型受体-抗体融合蛋白(益赛普)的减量方法。方法对入选的16例男性活动期AS患者进行1年的疗效观察。益赛普最初治疗量为25mg每周2次皮下注射,同时开始的治疗包括沙利度胺、帕夫林及双氯芬酸钠。当疾病得到缓解(Bath强直性脊柱炎活动指数<2.0,血沉<15mmH2O/1h及C-反应蛋白<0.8mg/dl),即将益赛普每隔2个月减半量。如果减量使患者症状加重或C反应蛋白水平反弹至异常水平,则将益赛普重新调整至前一个剂量,并于下次复查时评估以确定益赛普的剂量。结果经过1年的随访观察后,4名患者可将益赛普减量至25mg/3周,9名患者可减量至25mg/2周,1名患者可减量至25mg/周,2名患者由于疗效不满意于4个月时退出研究。结论沙利度胺、帕夫林及双氯芬酸钠联合低于推荐剂量的益赛普可以使大部分AS患者的病情维持在缓解状态。
Objective Safety and cost of anti-tumor necrosis factor-α treatment for ankylosing spondylitis （AS） are widely concerned in China.Here,we explored how to taper the dosage of etanercept.Methods Sixteen men with AS initially took 25 mg etanercept injection twice a week.Concomitant therapies included thalidomide （replaced by sulfasalazine in patients with peripheral arthritis）,total glucosides of paeony （TGP） and diclofenac sodium.After the disease was well controlled [Bath ankylosing spondyltitis disease activity index〈2.0,erythrocyte sedimentation rate （ESR） 〈15 mmH2O/1h,and C-reactive protein （CRP） 〈0.8 mg/dl],etanecept dosage was gradually reduced in a 2-month step.The tanercept would come back to original dosage if back pain,peripheral arthritis,extraarticular manifestations were aggravated or CRP was rebounded.Results After 12-month treatment,the dosage of etanercept could be eventually tapered from 2×25 mg/week to 25 mg/3 weeks in 4 patients,to 25 mg/2 weeks in 9 patients,and to 25mg/week in 1 patient.Two patients were retreated at month 4 because of dissatisfactory efficacy.No serious side effect of the combination treatments was observed.Conclusion The combination of thalidomide/sulfasalazine,TGP and diclofenac sodium with low dosage etanercept could maintain AS disease in remission.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2011年第1期57-59,63,共4页
Journal of China Medical University
基金
国家自然科学基金资助项目(30801204)
