Tính miễn dịch của các chất ức chế TNF dưới da và ý nghĩa lâm sàng của nó trong bối cảnh thực tế ở bệnh nhân viêm khớp liên quan đến cột sống

Springer Science and Business Media LLC - Tập 42 - Trang 1015-1025 - 2021
J. Hiltunen1, P. Parmanne1, T. Sokka2,3, T. Lamberg4, P. Isomäki5, O. Kaipiainen-Seppänen6, R. Peltomaa1, T. Uutela7, L. Pirilä8, K. Taimen8, M. J. Kauppi9,10, T. Yli-Kerttula11, R. Tuompo1, H. Relas1, S. Kortelainen8, K. Paalanen2,3, J. Asikainen2,3, P. Ekman11, A. Santisteban12, K.-L. Vidqvist5, K. Tadesse1, M. Romu1, J. Borodina2,3, P. Elfving6, H. Valleala1, M. Leirisalo-Repo1, V. Rantalaiho5, H. Kautiainen13, T. S. Jokiranta14, K. K. Eklund1,15
1Department of Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
2Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
3University of Eastern Finland, Kuopio, Finland
4United Medix Laboratories, Helsinki, Finland
5Department of Rheumatology, Tampere University Hospital, Tampere, Finland
6Department of Rheumatology, Kuopio University Hospital, Kuopio, Finland
7Department of Rheumatology, Central Hospital of Lapland, Rovaniemi, Finland
8Department of Rheumatology, Turku University Hospital, Turku, Finland
9Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
10University of Tampere, Tampere, Finland
11Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
12Department of Rheumatology, Mikkeli Central Hospital, Mikkeli, Finland
13Medcare Foundation, Äänekoski, Finland
14SYNLAB Finland, Helsinki, Finland
15Translational Immunology Research Program, Helsinki University and Orton Research Foundation, Orton Hospital, Helsinki, Finland

Tóm tắt

Một tỷ lệ đáng kể bệnh nhân mắc bệnh viêm khớp liên quan đến cột sống (SpA) đã được tiêm chủng với thuốc kháng TNF hoạt động dưới da mà họ đang sử dụng. Việc sử dụng đồng thời methotrexate (MTX) giúp bảo vệ khỏi sự tiêm chủng, trong khi sulfasalazine (SASP) thì không. Bệnh nhân mắc SpA đang sử dụng thuốc kháng TNF dưới da có thể hưởng lợi từ việc theo dõi nồng độ thuốc trong máu. Sự tiêm chủng vào các loại thuốc sinh học có thể dẫn đến giảm hiệu quả và tăng nguy cơ tác dụng phụ. Mục tiêu của nghiên cứu cắt ngang này là đánh giá mức độ và tầm quan trọng của sự tiêm chủng đối với các chất ức chế yếu tố hoại tử khối u (TNF) dưới da ở bệnh nhân viêm khớp liên quan đến cột sống trục (axSpA) trong bối cảnh thực tế. Một mẫu huyết thanh được lấy 1-2 ngày trước khi tiêm thuốc tiếp theo. Nồng độ thuốc trong máu, kháng thể chống thuốc (ADAb) và khả năng ức chế TNF đã được đo ở 273 bệnh nhân axSpA đang sử dụng thuốc kháng TNF dưới da. Hoạt động lâm sàng của SpA được đánh giá bằng chỉ số hoạt động bệnh Bath AS (BASDAI) và điểm số khớp gót Maastricht AS (MASES). ADAb được phát hiện ở 11% trong số 273 bệnh nhân: ở 21/99 (21%) bệnh nhân sử dụng adalimumab, 0/83 (0%) ở những người sử dụng etanercept, 2/79 (3%) ở những người sử dụng golimumab và 6/12 (50%) ở những người sử dụng certolizumab pegol. Sử dụng methotrexate làm giảm nguy cơ hình thành ADAb, trong khi sulfasalazine thì không. Sự hiện diện của ADAb dẫn đến nồng độ thuốc giảm và khả năng ức chế TNF giảm. Tuy nhiên, mức độ thấp của ADAb không có ảnh hưởng đến khả năng ức chế TNF và không tương quan với hoạt động bệnh. Nồng độ thuốc trong máu dưới mức mục tiêu được đồng thuận ở 36% bệnh nhân. Chỉ số khối cơ thể (BMI) cao tương quan với nồng độ thuốc trong máu thấp. Bệnh nhân có nồng độ thuốc trong máu thấp có hoạt động bệnh cao hơn. Sự hiện diện của kháng thể chống thuốc liên quan đến nồng độ thuốc trong máu thấp, và những bệnh nhân có nồng độ thuốc trong máu thấp có hoạt động bệnh cao hơn. Nồng độ thuốc trong máu nằm dưới mức mục tiêu ở một tỷ lệ đáng kể bệnh nhân và, do đó, việc đo nồng độ thuốc và ADAb có thể giúp tối ưu hóa điều trị cho bệnh nhân SpA.

Từ khóa

#miễn dịch học #yếu tố hoại tử khối u #viêm khớp #kháng thể chống thuốc #hoạt động bệnh

Tài liệu tham khảo

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