以生物製劑治療類風溼性關節炎患者的丙型干擾素釋放試驗

SERIAL INTERFERON-GAMMA RELEASE ASSAYS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH BIOLOGICAL AND TARGET-SYNTHETIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS

Objectives: The aims of this study were to assess serial interferon-gamma release assays (IGRAs) as a screening tool in patients with rheumatoid arthritis: (RA) treated with different biological and targetsynthetic DMARDs in Taiwan. Methods: We retrospectively collected records for 189 patients with rheumatoid arthritis receiving biological and target-synthetic DMARDs, who visited the Chang Gung Memorial Hospital in Taiwan between 2013 and 2017. All RA patients underwent semi-annual IGRA tests during treatment with biological and target-synthetic DMARDs. Results: The seroconversion rate of IGRA was 6.9% in patients with rheumatoid arthritis after biological and target-synthetic DMARDs treatment. The median seroconversion period was 19 months. Out of 13 patients with seroconversion, 8 (61.5%) patients were treated with a TNF blocker and 5 (38.5%) with a non-TNF blocker. All seroconversion patients were evaluated for possible active TB infection, of which 69.2% (9/13) received isoniazid chemoprophylaxis. There were no cases of active tuberculosis infection during serial IGRA tests. Risk factors included high baseline TBAg-nil/nil (OR 3.44, CI 6.64-1.78) or leflunomide (OR 11.51, CI 61.34-2.16). Conclusion: Our study revealed that patients with rheumatoid arthritis receiving long-term biological and target-synthetic DMARDs therapy had a low rate of IGRA seroconversion rate (6.9%). However, a higher odds ratio of seroconversion was found in patients with background leflunomide and high level of baseline TBAg-nil level. The clinical importance of IGRA seroconversion remains controversial; therefore, further long-term, large-scale investigations are needed. 目的：觀察interferon-γ release assays （IGRA）做為篩檢工具使用在以生物製劑治療類風濕性關節炎病人的研究結果。方法：回顧性研究2013年至2017年台灣長庚醫院治療的189例類風濕性關節炎並接受生物製劑治療的患者。所有類風濕關節炎患者會在生物製劑治療期間接受半年一次的IGRA檢驗。結果：使用生物製劑治療的類風濕關節炎患者IGRA陰轉陽比例為6.9％。陰轉陽的時間中位數為19個月。在13例IGRA陰轉陽患者中，8例（61.5％）患者有接受TNF blocker治療，5例（38.5％）接受non-TNF blocker治療。所有陰轉陽患者都會被評估是否有活動性結核的感染，69.2％（9／13）陰轉陽病人接受isoniazid預防性治療。此研究中沒有病人有結核感染。危險因素包括高基準的TBAg-nil／nil（OR3.44，CI6.64－1.78），使用leflunomide（OR11.51，CI61.34－2.16）。結論：我們的研究顯示接受長期生物製劑治療的類風濕性關節炎患者的IGRA陰轉陽較低（6.9％）。高基準的TBAg-nil和使用leflunomide的患者陰轉陽的比例比較高。然而IGRA的臨床重要性仍然有其爭議性，需要進一步長期並更大規模的研究。