Romatoid Artrit Tanılı Hastalarda Biyolojik İlaç Sağkalımını Etkileyen Faktörler: Türkiye’den Tek Merkezli Bir Çalışma

Amaç: Çalışmanın amacı; erişkin romatoid artrit (RA) hastalarında biyolojik ajan tedavilerinde ilaçta sağkalımı etkileyen faktörleri belirlemektir. Gereç ve Yöntemler: Çalışmamızda 2013-2016 yılları arasında Trakya Üniversitesi Tıp Fakültesi Hastanesi Romatoloji kliniğinde RA tanısı ile ayaktan ya da yatırılarak takip edilmiş 245 hastanın verileri retrospektif olarak incelendi. Otuz yedi hastanın verileri eksik olduğundan çalışmadan dışlandı. Kalan 208 hastanın verileri değerlendirildi. Bulgular: Çalışmamızda ilerleyen yaşın ilaç sağkalım süresini 0.48 kat ( %95 güven aralığı 0.23-0.97), kadın cinsiyetin 3 kat (%95 güven aralığı 1.09-10.3), hiperlipidemi varlığının 8 kat (%95 güven aralığı 2.12-32.5), tedavi öncesi eritrosit sedimantasyon hızı (ESH) yüksekliğinin 1.03 kat (%95 güven aralığı 1.01-1.04), Hepatit B yüzey antijen pozitifliğinin (HBsAg) 9.2 kat (%95 güven aralığı 2.4-35.3), sitrulinlenmiş proteine karşı oluşan antikor (Anti-CCP) pozitifliğinin 2.9 kat (%95 güven aralığı 1.3-6.4), glukokortikoid kullanımının 0.36 kat (%95 güven aralığı 0.17-0.76) kısalttığını gösterdik. Buna karşın; kronik böbrek hasarı olan hastalarda ilaçta kalma süresinin 0.18 kat (%95 güven aralığı 0.06-0.57) uzadığı gözlemlenmiştir. Sonuç: RA hastalarına biyolojik ilaç başlarken bazı parametreler ilaçta sağ kalımı ön görmede yardımcı olabilir. Etki sırasına gore; HBsAg pozitifliği, hi- perlipidemi varlığı, kadın cinsiyet, anti-CCP pozitifliği, ESH yüksekliği, ileri yaş ve glukokortikoid kullanımı ilaçta kalma süresi için negatif marker iken; kronik böbrek hasarı ise pozitif marker olabilir.

Anahtar Kelimeler:

Biyolojik ajanlar, Romatoid artrit, Tümör nekroz faktör

Factors Affecting Survival on Biologic Treatments in Patients with Rheumatoid Arthritis: A Single-Center Study From Turkey

Objective: In our study, we aimed to determine the factors affecting survival on biologic treatment in adult rheumatoid arthritis (RA) patients using biolog- ical drugs. Materials and Methods: In our study, the data of 245 patients who were followed up with the diagnosis of RA in the Rheumatology Clinic of Trakya University Medical Faculty Hospital between 2013 and 2016 were analyzed retrospectively. 37 patients were excluded due to missing data. The data of the remaining 208 patients were evaluated. Results: In our study, we found that drug survival was reduced by 0.48 times (95% CI 0.23-0.97) in elderly patients and 3 times (95% CI 1.09-10.3) in females. According to the results of our study, drug survival is shortened 8 times (95% CI 2.12-32.5) in patients with hyperlipidemia and 1.03 times (95% CI 1.01-1.04) in patients with high pretreatment erythrocyte sedimentation rate (ESR). In addition, we found that shorter drug survival 9.2 times (95% CI 2.4-35.3) in patients with Hepatitis B surface antigen (HBsAg) positivity, 2.9 times (95% CI 1.3-6.4) in patients with antibody positivity against citrullinated protein (ACPA), in patients using glucocorticoids 0.36 times (95% CI 0.17-0.76). Despite that; in patients with chronic kidney disease, drug survival was prolonged by 0.18 times (95% CI 0.06-0.57). Conclusion: When starting biologic drugs in RA patients, some parameters may help to predict drug survival. According to the order of effect; while HBsAg positivity, presence of hyperlipidemia, female gender, ACPA positivity, high ESR, advanced age and glucocorticoid use were negative markers for drug survival; chronic kidney damage can be a positive marker.

Keywords:

Biological agents, Rheumatoid arthritis, Tumor necrosis factor,

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