Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Rheumatology (Oxford). 2012 Jun;51(6):1120-8. doi: 10.1093/rheumatology/ker516. Epub 2012 Feb 15.
To compare the prevalence of and predictors for sustained drug-free remission in two cohorts of patients with recent-onset RA treated with DAS-driven therapy or non-DAS-driven therapy.
Sustained drug-free remission was assessed after 5 years of follow-up in 508 patients treated with DAS-driven therapy (DAS ≤ 2.4) in a randomized treatment cohort, and in 424 patients who received non-DAS-driven therapy in a prospective inception cohort. The design of the DAS-driven cohort required systematic joint assessments with DAS-driven restart of therapy. Predictors for remission were identified by univariable and multivariable logistic regression in each cohort separately and in a combined multivariate logistic regression analysis corrected for propensity scores, including a sensitivity analysis on patients receiving initial monotherapy.
Patients in the DAS-driven cohort had more active disease at baseline, but the prevalence of sustained drug-free remission was similar after DAS-driven (9.8%) and non-DAS-driven therapy (10.6%). Among patients with ACPA, drug-free remission was more frequently achieved after DAS-driven than after non-DAS-driven therapy (5.4 vs. 2.1%, OR = 2.68, 95% CI 0.97, 7.43). Absence of ACPA and short symptom duration were independent predictors for sustained drug-free remission in both cohorts. Initial treatment choice and inclusion period were not predictive. The sensitivity analysis yielded comparable results.
Retrospectively comparing a DAS-driven to a non-DAS-driven therapy cohort, the occurrence and predictors of sustained drug-free remission were similar. The DAS-driven cohort had a more unfavourable prognosis. DAS-driven therapy may improve the chance of sustained drug-free remission in ACPA-positive patients with recent-onset RA.
比较接受 DAS 驱动治疗或非 DAS 驱动治疗的近期发作 RA 患者两组中持续无药物缓解的发生率和预测因素。
在一项随机治疗队列中，对 508 例接受 DAS 驱动治疗（DAS≤2.4）的患者进行了 5 年随访后评估持续无药物缓解，在一项前瞻性起始队列中对 424 例接受非 DAS 驱动治疗的患者进行了评估。DAS 驱动队列的设计需要进行系统的关节评估，并根据 DAS 驱动重新开始治疗。在每个队列中分别进行单变量和多变量逻辑回归分析，确定缓解的预测因素，并在包括倾向评分校正的联合多变量逻辑回归分析中进行校正，包括对接受初始单药治疗的患者进行敏感性分析。
DAS 驱动队列的患者在基线时疾病更为活跃，但在 DAS 驱动（9.8%）和非 DAS 驱动治疗（10.6%）后持续无药物缓解的发生率相似。在 ACPA 阳性患者中，DAS 驱动治疗后无药物缓解的发生率高于非 DAS 驱动治疗（5.4%比 2.1%，OR=2.68，95%CI 0.97，7.43）。在两个队列中，无 ACPA 和短病程均为持续无药物缓解的独立预测因素。初始治疗选择和纳入期没有预测作用。敏感性分析得出了类似的结果。
回顾性比较 DAS 驱动与非 DAS 驱动治疗队列，持续无药物缓解的发生和预测因素相似。DAS 驱动队列的预后较差。DAS 驱动治疗可能会增加 ACPA 阳性近期发作 RA 患者持续无药物缓解的机会。
