Suade Özlem BADAK, Süleyman ÖZBEK, Neslihan GÖKCEN, Esra KAYACAN ERDOĞAN

Romatoid artrit ve Ankilozan Spondilit Tedavisinde Biyolojik Ajanların Değişimlerinin Analizi

GİRİŞ ve AMAÇ: Hastalığı modifiye edici biyolojikantiromatizmal ilaçlar (bDMARDs), romatoid artrit (RA) veankilozan spondilit (AS) tedavisinde kullanılmaktadırlar. Buçalışmada, bDMARDs değişim paternlerinin, ilaç tedavisindekalım sürelerinin ve RA ile AS hastalarında ilaç değişimnedenlerinin gerçek dünya verileri ışığında araştırılmasıamaçlandı. YÖNTEM ve GEREÇLER: Çalışma, retrospektif, tekmerkezli, gözlemsel bir çalışma olarak dizayn edildi.Çalışmaya, en az 1 kez bDMARDs değişimi yapmış 102 hasta(55 RA ve 47 AS) dahil edildi. İlaç tedavisinde kalım sürelerive bDMARDs değişim nedenleri kaydedildi. Her biyolojik ajaniçin ilaç devamlılık sürelerini analiz etmek ve gruplar arasıkarşılaştırma yapmak için Kaplan-Meier analizi ve Log-Ranktesti kullanıldı. BULGULAR: Ellibeş (%53.9) hasta RA iken, 47 (%46.1) hastaAS idi. İlk değişim oranı RA hastalarında %23.7 iken, bu oranAS hastalarında %21.5 idi. İkinci ilaç değişim oranları RAhastalarında %5.5 ve AS hastalarında %4.3 bulundu. En sıkgörülen üç ilaç değişim nedeni sırası ile; ilaç etkinliğininkaybı, yeni gelişen klinik durumlar ve yan etkilerdi. Kaplan Meier analizie göre, ilk biyolojik ilaç tedavisinde kalım süresi,AS’de RA’ya göre daha yüksekti (p=0.039, Log-Rank test). İlkseçilen bDMARD’lar arasında, Etanercept ile ilaç tedavisindekalım süresi AS’de RA hastalarından daha uzundu (p=0.036,Log-Rank test). TARTIŞMA ve SONUÇ: bDMARDs’ların ilk ve ikinci ilaçdeğişim oranları ve değişim nedenleri gruplar arasındabenzerdi. İlk bDMARD tedavisinde kalım süresi, AShastalarında RA hastalarından daha uzundu.

Analysis of Switching Biological Agents in Treatment ofRheumatoid Arthritis and Ankylosing Spondylitis

INTRODUCTION: Biological disease-modifying anti rheumatic drugs (bDMARDs) have been used in the treatmentof rheumatoid arthritis (RA) and ankylosing spondylitis (AS).The aim of the study was to investigate the switching patternsof bDMARDs, the drug survival rates and the reasons forswitching in patients with RA and AS by means of Real-Worlddata. METHODS: The study was designed as retrospective, single center, and observational. One hundred and two patients (55RA, 47 AS) who switched at least one biologic agent wereincluded in the study. The drug survival time and causes ofswitching bDMARDs were recorded. The Kaplan-Meieranalysis and Log-Rank tests were performed to analyze thesurvival curves of each biological agent and compare theresults between groups. RESULTS: Of 102, 55 patients (53.9%) were RA, 47 patients(46.1%) were AS. First switching ratio of RA was 23.7% whilstit was 21.5% in AS. Second switching rates were 5.5% and4.3% in RA and AS patients, respectively. The most threecauses of switching were loss of efficacy, the occurrence ofnew clinical conditions, and adverse events. In the Kaplan Meier analysis, the higher continuance of using the firstbDMARD was observed in AS than in RA (p=0.039, Log-Ranktest). Among the first bDMARDs, the drug survival rate ofEtanercept was higher in AS patients than in RA. (p=0.036,Log-Rank test). DISCUSSION AND CONCLUSION: The first and secondswitching ratios of bDMARDs, and switching causes weresimilar between groups. The drug survival rate was longer inAS than in RA.

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