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Analysis Of The Efficacy,Safety And Economic Cost Of Adalimumab And Tofacitinib In The Treatment Of Rheumatoid Arthritis

Posted on:2022-05-12Degree:MasterType:Thesis
Country:ChinaCandidate:D JiangFull Text:PDF
GTID:2494306329498294Subject:Internal Medicine
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Background:Rheumatoid arthritis(RA)is a systemic chronic autoimmune inflammatory disease.The etiology and pathogenesis of RA are still unclear.Chronic synovitis,pannus,articular cartilage and bone damage are the main pathological features of RA.The main clinical manifestations are symmetrical joint swelling and pain with morning stiffness.In advanced patients,joint deformities may occur,and even lead to disability,which brings a great burden to the family and society.Therefore,early diagnosis and treatment of RA,control of the disease progression of RA patients,and suppression of disease activity can effectively improve the prognosis of patients.Currently,the treatment drugs for RA mainly include:non-steroidal anti-inflammatory drugs(NSAIDs),traditional synthetic disease modifying anti-rheumatic drugs(cs DMARDs),Target synthetic disease modifying anti-rheumatic drugs(ts DMARDs),biological disease modifying anti-rheumatic drugs(b DMARDs)and glucocorticoids.Adalimumab(ADM)is the first fully humanized monoclonal antibody that specifically binds to TNF-α,which can effectively inhibit the cytokine TNF-α.Tofacitinib is the first-generation oral drug that selectively inhibits JAK1 and 3,and has little effect on JAK2 and TYK2[1]。Studies have shown that tofacitinib is effective for RA as a single-agent therapy or in combination with DMARDs.Tofacitinib has been officially approved by the US FDA for the treatment of RA patients who do not respond well to MTX[2-4]Objective:Two groups of RA patients treated with ADM and tofacitinib were followed up for a period of 6 months respectively,and ADM and tofacitinib were compared in terms of clinical efficacy indicators,disease activity indicators,quality of life indicators,safety,and economic costs.So as to provide reference for clinicians to choose treatment drugs.Method:Selected 40 cases of moderate and severe rheumatoid arthritis patients who were treated in the outpatient clinic of the Department of Rheumatology and Immunology of the Hospital from September 2018 to December 2019 as the research objects for a6-month follow-up treatment,in which adalimumab(Xiumei)Le)29 patients were treated and 11 patients were treated with tofacitinib.Evaluate and record the clinical score index(SJC,TJC,PGV,Ph GV,PPS),quality of life(HAQ-DI),laboratory tests(ESR,CRP,blood routine,blood biochemistry,urine routine,blood coagulation function)of patients at different time points,Autoantibodies),adverse events,treatment costs.ADM and tofacitinib were compared in terms of clinical efficacy indicators,disease activity indicators,quality of life indicators,safety,and economic costs.Result:1.Curative effect indicators:ACR20,50,and 70 showed an overall upward trend within 24 weeks of treatment in the two groups.Select the generalized estimation equation to analyze the two groups of ACR20,50,70 as a whole:p>0.05.Compared with 8w,there was no difference in the change range(Δ)of the main efficacy index ACR20 between the two groups(p>0.05).2.Disease activity indicators and quality of life indicators:overall comparison between groups:DAS28-CRP,TJC,SJC,PPS(VAS)and HAQ-DI were not different(p>0.05).Overall comparison within the group:The disease activity indexes and quality of life indexes after treatment in the ADM group were significantly different from those before treatment(p<0.01).HAQ-DI after treatment in the tofacitinib group was significantly different than before treatment(p<0.01);DAS28-CRP and TJC after treatment were different from before treatment(p<0.05);after treatment,SJC and PPS(VAS)were higher than before treatment No difference(p>0.05).Comparison of each time point in the group compared with before treatment:ADM group:DAS28-CRP,TJC,SJC,PPS(VAS)at each time point after treatment were lower than before treatment(p<0.05);at 12w,16w,20w,24w HAQ-DI was lower than before treatment(p<0.05).Tofacitinib group:DAS28-CRP:12w,16w,20w,24w were all lower than before treatment(p<0.05);TJC:20w,24w were all lower than before treatment(p<0.05);SJC,HAQ-DI:16w,20w,24w were all lower than before treatment(p<0.05);PPS:8w,12w,16w,20w,24w were lower than before treatment(p<0.05).There was no difference in the change amplitude(Δ)between the ADM group and the tofacitinib group at each time point after treatment compared with before treatment(p>0.05).3.Safety evaluation:There was no difference in the incidence of adverse reactions between the two groups(p>0.05).4.Economic cost:The cost-effectiveness ratio of tofacitinib is lower than that of ADM.Conclusion:1.Both ADM and tofacitinib are effective in treating RA patients.2.Compared with tofacitinib,ADM can reduce disease activity faster and improve quality of life.3.There is no difference in the incidence of adverse reactions between ADM and tofacitinib.4.The economic cost of tofacitinib for RA patients is lower than that of ADM.
Keywords/Search Tags:Rheumatoid Arthritis Tofacitinib, Adalimumab, Efficacy, Safety, Economic Cost
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