使用腫瘤壞死因子抑制劑或恩瑞舒（Abatacept）的類風濕關節炎病人之併用疾病調節抗風濕藥物與抗環瓜氨酸抗體濃度下降的關聯

Association between a decrease in anti-cyclic citrullinated protein levels with the concomitant use of disease-modifying antirheumatic drugs in rheumatoid arthritis patients treated with tumor necrosis factor inhibitors or abatacept

目的：探討在使用腫瘤壞死因子抑制劑或恩瑞舒的類風濕關節炎病人，併用疾病調節抗風濕藥物治療與抗環瓜氨酸抗體濃度下降的關聯性。方法：我們回溯性收錄使用腫瘤壞死因子抑制劑（n = 76）或恩瑞舒（n = 23）的抗環瓜氨酸抗體陽性之類風濕關節炎病人，並追蹤其生物製劑使用前（CCP0）與後六個月（CCP1）的血清抗環瓜氨酸抗體濃度，CCP1減CCP0為負值表示抗環瓜氨酸抗體濃度隨治療下降。我們使用多變向邏輯迴歸分析檢定年齡、性別、生物製劑、病程與疾病調節抗風濕藥物對抗環瓜氨酸抗體濃度下降的影響。結果：38位（50.0%）使用腫瘤壞死因子抑制劑病人與7位（30.4%）使用恩瑞舒病人併用斯樂（Sulfasalazine）治療（p = 0.099）。59位（77.6%）使用腫瘤壞死因子抑制劑病人與14位（60.9%）使用恩瑞舒病人的抗環瓜氨酸抗體濃度隨治療下降（p = 0.110）。經校正潛在干擾因子後，併用斯樂治療與抗環瓜氨酸抗體濃度下降呈顯著相關（OR, 3.41；95% CI, 1.02–11.41；p = 0.047），此顯著正相關聯性仍見於使用腫瘤壞死因子抑制劑病人（OR, 5.19；95% CI, 1.16–23.29；p = 0.031），但在使用恩瑞舒病人中此相關性並不顯著。結論：在使用腫瘤壞死因子抑制劑或恩瑞舒的類風濕關節炎病人中，併用斯樂治療與抗環瓜氨酸抗體濃度下降有顯著相關，特別是在使用腫瘤壞死因子抑制劑病人上。本研究主要限制為在無法得知病人吸菸情況。併用斯樂治療與抗環瓜氨酸抗體濃度下降的關係值得後續臨床試驗確認。

Objective: To investigate the association between the concomitant use of Disease-modifying Antirheumatic Drugs (DMARDs) and a decrease in anti-cyclic citrullinated protein (CCP) levels amongst patients with Rheumatoid Arthritis (RA) treated with Tumor Necrosis Factor inhibitor drugs (TNFi) or abatacept. Methods: We retrospectively included anti-CCP-positive RA patients treated with TNFi (n = 76) or alternatively, abatacept (n = 23). We followed up the anti-CCP levels at baseline (CCP0) and 6 months later (CCP1). A decrease in anti-CCP levels after therapy was identified if CCP1 minus CCP0 was less than 0. A multivariable logistic regression analysis was used to examine the influence of age, gender, biologic agents, disease duration, and DMARDs on the risk of anti-CCP decrease.Results: Thirty-eight (50.0%) of the 76 TNFi users and 7 (30.4%) of the 23 abatacept users concomitantly used sulfasalazine (SSZ) (p = 0.099). Of the 76 TNFi users and 23 abatacept users, 59 (77.6%) and 14 (60.9%) showed a decrease in anti-CCP levels (p = 0.110), respectively. After adjusting for potential confounders, concomitant use of SSZ was associated with an anti-CCP level decrease (OR, 3.41; 95% CI, 1.02–11.41; p = 0.047). This positive correlation remained significant in the TNFi group (OR, 5.19; 95% CI, 1.16–23.29; p = 0.031), but not in the abatacept group.Conclusions: Concomitant use of SSZ was associated with decreased anti-CCP levels in RA patients treated with either a TNFi or abatacept, particularly amongst TNFi users. The lack of information on individual smoking status is a major limitation. The potential benefit surrounding concomitant SSZ use with regards to anti-CCP level decrease warrants future clinical studies.