奈立膦酸治疗AS的抗炎作用与英夫利昔单抗相当,但具有增加骨密度的作用
译者:韩健 校对:马丹 审核:张莉芸
Abstract: -IVE: The -ive of this study was to evaluate if the anti-inflammatory
properties of bisphosphonates and their effect on bone turnover could be useful in the
treatment of AS. METHODS: Sixty patients were consecutively assigned in a 1:1 ratio in a 6-month open-label, single-centre study on active AS to receive monthly i.v. neridronate (100 mg) or standard infliximab (5 mg/kg) therapy. RESULTS: A significant reduction in the mean BASDAI was observed over 6 months of either neridronate (-1.72) or infliximab (-1.62)
administration. The BASFI decreased significantly at 3 and 6 months in the neridronate arm,
while in the infliximab group a significant reduction at 3 months but not 6 months was observed.
The 10-cm visual analogue scale for axial pain decreased significantly and comparably
at 3 and 6 months in both groups. No significant differences between treatment arms for all
these changes were observed at both 3 months and the final assessment.
The BASMI was not significantly modified in the neridronate or infliximab group.
No significant variations of BMD were observed in the infliximab group,
while in patients treated with neridronate a significant increase was observed at the lumbar spine.
CONCLUSION: High i.v. doses of the amino-bisphosphonate neridronate are as effective as infliximab therapy in reducing disease
activity in AS patients, with additional benefits on BMD changes. Further studies to confirm these
results over a longer time - are warranted together with the possibility to explore
the long-term efficacy of a combination of lower anti-TNF doses with bisphosphonates.
摘要:目的:评价二膦酸盐的抗炎作用和它对骨转化的影响是否可以在强直性脊柱炎(AS)治疗中起有效作用。方法:60例活动期AS患者按1:1的比例分配到一项为期6个月的开放性、单中心研究中,每月分别静脉注射奈立膦酸(100mg) 或标准剂量的英夫利西单抗(5mg/kg)。结果:使用奈立膦酸或英夫利昔单抗治疗的患者在6个月时AS疾病活动指数(BASDAI)均显著降低;奈立膦酸治疗组的患者在3个月和6个月时AS功能指数(BASFI)明显降低,而英夫利西单抗治疗组的BASFI在3个月时明显降低,6个月时则降低不明显;两组患者的视觉模拟疼痛评分(0-10分)在3个月和6个月时均有同等程度地显著降低;两个治疗组的这些变化在3个月和研究终点并无显著差异。两组患者的AS测量指数(BASMI)无明显变化。英夫利西单抗治疗组患者的骨密度(BMD)无显著变化,而奈立膦酸治疗组患者的腰椎BMD有明显的增加。结论:静脉注射高剂量的氨基酰二膦酸盐奈立膦酸在降低AS疾病活动方面和使用英夫利昔单抗具有同样的疗效,不同的是奈立膦酸可以在BMD的变化上起到有益的作用。尚需进一步的研究来证实该结果,同时探索联合低剂量抗TNF拮抗剂和二磷酸盐联合治疗AS的长期有效性。
引自:Viapiana O, Gatti D, Idolazzi L,et al.Bisphosphonates vs infliximab in ankylosing spondylitis treatment. Rheumatology (Oxford). 2014 Jan; 53(1):90-94.