對於類風濕關節炎Abatacept具有持續性療效：一個單一醫學中心的回顧性觀察研究

The sustained therapeutic effectiveness of abatacept in patients with rheumatoid arthritis: an observational study in a medical centre

目的：評估Abatacept在類風濕關節炎病人的成效，以及對於用過其他生物製劑無效，病程超過五年，或類風濕因子陰性或抗瓜氨酸化蛋白抗體陰性的類風濕關節炎病人，治療成效為何。方法：針對2013年至2015年在單一醫學中心被確診為類風濕關節炎的病人，在接受Abatacept注射前、第六個月、第九個月及第十二個月評估不同時期28處關節疾病活動度評估（DAS28）的變化，得到三個區間的DAS28變化、前六個月的短期變化和注射一年的長期變化。並把病人根據可能會導致影響ABA效果及預後的因素進行分組：1）是否用過其他生物製劑而效果不佳，2）疾病是否超過五年，3）有無類風濕因子，4）有無抗瓜氨酸化蛋白抗體，並比較各組間是否在治療成效上有所差異結果：我們一共收集27位類風濕關節炎接受Abatacept的病人，觀察病人於注射前（mean ± SD = 6.98 ± 0.38）、第六個月（3.74 ± 0.52）、第九個月（3.00 ± 0.58）、第十二個月（2.73 ± 0.53）的DAS28，發現無論是注射前到第六個月（p < 0.001），第六個月到第九個月之間的DAS28變化（p < 0.001），第九個月到第十二個月之間的DAS28變化（p = 0.009），以及注射前到第十二個間的DAS28變化（p < 0.001），DAS28都呈現有顯著意義的下降趨勢。然而在前六個月的短期變化及注射一年的長期變化，無論是否用過其他生物製劑而效果不佳、疾病是否超過五年、有無類風濕因子、有無抗瓜氨酸化蛋白抗體，各組病人之間都沒有顯著差異。結論：Abatacept有效改善了類風濕關節炎病人DAS28，使用後無論短期變化或長期變化都可見到效果。無論病人本身是否用過其他生物製劑而反應不佳、病程是否超過五年、是否有類風濕因子、是否有抗瓜氨酸化蛋白抗體，使用上並無區別。Abatacept可做為類風濕關節炎病人用過其他生物製劑而反應不佳、病程超過五年、類風濕因子陰性或抗瓜氨酸化蛋白抗體陰性時的治療選擇。

Objective: To evaluate the effectiveness of Abatacept (ABA) among patients with rheumatoid arthritis (RA) and the difference of the effectiveness to ABA among different subgroups of patients with RA. Methods: We conducted a retrospective observational study of patients with established RA who used ABA in a medical centre in Taiwan from 2013 to 2015. Patients received disease-modifying antirheumatic drugs at first, and then they received ABA as the first biologic agent, or after an inadequate response to other biologic agents. The disease activities of RA were evaluated four times by the Disease Activity Score of 28 joints (DAS28) before injection, and at Months 6, 9 and 12. Results: We collected 27 patients with RA who met the 1987 ACR RA classification criteria and received ABA for at least one year from 2013 to 2015. The mean age was 58.74 years-old (88.9% were female). Under the continuous use of ABA, improvement of the DAS28 were all noted in intervals during the first year, from the first interval (beginning to Month 6) (p < 0.001), the second interval (Month 6 to 9) (p < 0.001), the third interval (Month 9 to 12) (p = 0.009), and from the beginning to Month 12 (p < 0.001). Comparing patients who were naive to biologic agents and experienced with an inadequate response to other biologic agents, there was no significant difference of ABA effectiveness. RA duration or existence of RF or ACPA did not impact the effectiveness to ABA in the study. Conclusion: RA patients who were treated by ABA had a significant improvement of the DAS28 at all intervals of evaluations during the first year. ABA may be an effective choice for RA patients no matter if they were naive to biologic agents or experienced with an inadequate response to other biologic agents, had disease duration more or less than five years, or existence of RF or ACPA.