류마티스 관절염 환자에서 항종양괴사인자 제제 치료 후 임상 반응 및 관찰 평가

Abstract

Rheumatoid arthritis(RA) is a chronic inflammatory disease that causes joint damage and bone erosion, and is associated with increased risk of cardiovascular disease (CVD). Anti-tumor necrosis factor (anti-TNF) agents are first-line biological DMARDs (Disease-Modifying Anti-rheumatic Drugs), which can reduce the disease activity of RA and decrease the risk for cardiovascular disease. Because of the lack of studies on anti-TNF agents in Korea, this study was conducted to observe and evaluate the clinical responses and clinical parameters inpatients with RA following anti-TNF administration, and to investigate the factors that influence them. In this study, the medical records of patients who were administered anti-TNF agent for RA, from September 2012 to August 2015, were analyzed retrospectively. The clinical responses (ESR, CRP, swollen joint count, tender joint count), CVD monitoring factors (glucose, total cholesterol, triglyceride level), and adverse effect monitoring factors (AST, ALT, white blood cell count, hemoglobin, neutrophils count, platelet count, serum creatinine) were observed before the drug administration, and follow-up observation were also made at 3, 9, and 15-month post-administration. One-hundred-four patients of 306 patients were selected based on inclusion and exclusion criteria, and were administered etanercept (n=38), adalimumab (n=46), and infliximab (n=20). After 3 months, the clinical response significantly decreased, regardless of the type of anti-TNF agent used, and the levels were maintained up to 15 months (p<0.05). After anti-TNF agent administration, the CRP and total cholesterol levels, which are indicators of risk of cardiovascular disease, decreased after 3 months, and these results were more significant in the group with concomitant administration of MTX. Platelet count and neutrophils count decreased after 3 months of anti-TNF agent administration, regardless of the type of anti-TNF agent used, and the levels were maintained up to 15 months (p<0.05). The platelet count also significant decreased, particularly in the group of patients aged 65 years and older. Serum creatinine showed constant increase over the course of 15 months, and it was not affected by the type of anti-TNF agent used. This study was conducted as an observation of the clinical responses (efficacy and safety) and follow-up evaluation of anti-TNF agent in patients with RA, and it is believed that future multi-institutional prospective studies can provide basic clinical information on anti-TNF agent administration and ensure customized patient treatment.