接受TNF拮抗剂治疗的韩国AS病人发生结核感染的情况

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J Rheumatol. 2011 Aug 15. [Epub ahead of print]   Incidence of Tuberculosis Among Korean Patients with Ankylosing Spondylitis Who Are Taking Tumor Necrosis Factor Blockers.   Kim EM, Uhm WS, Bae SC, Yoo DH, Kim TH.   Source From the Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.   Abstract   OBJECTIVE: To assess the incidence and relative risk of new tuberculosis (TB) infections in Korean patients with ankylosing spondylitis (AS) and patients with AS who are undergoing treatment with tumor necrosis factor (TNF) blockers. METHODS: New cases of TB were identified by reviewing the medical records of 919 patients with AS not treated with TNF blockers and those of 354 patients with AS treated with adalimumab (n = 66), infliximab (n = 78), or etanercept (n = 210) between 2002 and 2009. Reference data were obtained from the Korean National Tuberculosis Association. RESULTS: The mean incidence rate of TB was 69.8 per 100,000 person-years (PY) in the general population, 308 per 100,000 PY in the TNF blocker-naive AS cohort, and 561 per 100,000 PY in the TNF blocker-exposed AS cohort. The incidence rate of TB in the infliximab-treated AS cohort (540 per 100,000 PY) was higher than that in the adalimumab-treated AS cohort (490 per 100,000 PY). No cases of TB occurred in the etanercept-treated AS cohort. Comparing the relative risks of TB infections between the TNF blocker-exposed AS cohort and the TNF blocker-naive AS cohort, no statistically significant difference was identified (risk ratio 0.53; 95% CI 0.144-1.913). CONCLUSION: The risk of TB was higher in the TNF blocker-naive AS cohort than it was in the general population. However, the risk of TB was not increased in the TNF blocker-exposed AS cohort compared with the TNF blocker-naive AS cohort. Among patients with AS, etanercept is associated with a lower risk of TB compared with monoclonal antibodies. PMID: 21844149

接受TNF拮抗剂治疗的韩国AS病人发生结核感染的情况   Kim EM, et al.   目的：评估韩国强直性脊柱炎(AS)病人群以及接受TNF拮抗剂治疗的韩国AS病人中新发结核(TB)感染的发生率以及相对风险。   方法：通过回顾医疗记录，发现在2002至2009年间未曾接受抗TNF治疗的AS病人有919例，接受抗TNF治疗的AS病人有354例，其中有阿达木单抗（N =66）、英夫利昔（N = 78）和依那西普（N= 210）。记录这些病人中的新发TB感染。参照数据来自韩国国家抗结核协会。   结果：总人群中结核病的平均发病率为69.8/10万病人年(PY)，未经抗TNF治疗的AS病人群中该数字为308/10万PY，抗TNF治疗AS病人群为561/10万PY。英夫利昔治疗的AS队列中结核病发病率(540/10万PY)高于阿达木治疗的AS队列(490/10万PY)。接受依那西普治疗的AS队列中未见结核报告。比较接受与未接受抗TNF治疗的AS队列，TB感染风险并无显著差异（风险比为0.53，95％CI: 0.144-1.913）。   结论：未经抗TNF治疗的AS病人的结核感染发生风险高于总人群。然而，TNF拮抗剂治疗组病人结核风险并不高于不接受抗TNF治疗的患者。在肿瘤坏死因子受体阻滞剂，天真，队列比在一般人群中结核病的风险较高。然而，结核病的风险没有增加，在队列阻滞剂暴露肿瘤坏死因子与肿瘤坏死因子受体阻滞剂，与单克隆抗体药物治疗组相比，依那西普治疗AS病人的结核感染风险要低一些。