停用依那西普后沙利度胺对维持强直性脊柱炎患者病情缓解的影响

目的 评价停用依那西普后沙利度胺可否维持强直性脊柱炎(AS)患者病情的缓解.方法 105例经过为期12周的依那西普治疗后达到了AS疗效评价标准(ASAS)20改善标准并能定期接受随访的患者随机分为3组,第1组给予沙利度胺150 mg.每日1次,晚上口服;第2组给予柳氮磺吡啶(SASP)1.0 g,每日2次口服;第3组仅给予原先使用的非甾体抗炎药(NSAIDs)维持治疗.每个月定期随访1次,随访内容包括:Bath AS疾病活动性指数(BASDAI)、Bath AS功能指数(BASFI)、患者对病情的总体评价(PGA)、脊柱痛等的变化.以病情复发作为随访终点.结果 有100例患者最终完成了随访,其中沙利度胺组30例.SASP组33例,NSAIDs组37例,平均随访时间(5±4)个月,最长的患者随访了12个月.随访结束时沙利度胺组维持病情缓解率为40%(12例),SASP组为15%(5例),NSAIDs组为11%(4例),沙利度胺组的维持缓解率要显著高于SASP组(P=0.0265)和NSAIDs组(P=0.0053),而SASP组和NSAIDs组维持缓解率的差异无统计学意义(P=0.5881).结论 沙利度胺有助于停用依那西普后维持AS患者病情的缓解.

Thalidomide successfully maintains remission in ankylosing spondylitis after discontinuing etanercept treatment

Objective To determine whether thalidomide can maintain remission after discontinuing the treatment of etanercept in ankylosing spondylitis (AS). Methods One hundred and five patients with active AS treated with etanercept 50 rag/week for 12 weeks and attained an ASAS20 response at week 12. They were randomly assigned to receive thalidomide 150mg/night, sulfasalazine (SASP) 2.0 g/d, or non-steroidal anti-inflammatory durgs (NSAIDs) only. All patients were followed monthly for BASDAI, BASFI, PGA and spinal pain VAS. A Kaplan-Meier survival analysis was used to calculate the probability of a relapse. Results One hundred patients completed the follow-up. Thirty patients were treated with thalidomide, 33 patients with SASP and 37 patients with NSAIDs only. The mean follow-up time was 5.1 months and the longest time was 12 months. At the end of the follow-up, the percentage of patients who maintained remission in the thalidomide group was 40%, much higher than SASP group (15%) and NSAIDs group 11% (P=0.0265 and 0.0053 respectively). No difference was found between the remission rate of SASP and NSAIDs only group (P=0.5881). Conclusion Thalidomide can successfully maintain remission of AS after discontinue etanercept treatment.