Department of Rheumatology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Hungary, Kálvária sgt. 57., Szeged, 6725, Hungary.
Clin Rheumatol. 2014 Mar;33(3):329-33. doi: 10.1007/s10067-014-2508-3. Epub 2014 Feb 5.
The objectives of this study are to explore the causes of permanent discontinuation of biological therapies in inflammatory rheumatic diseases and to analyse the subsequent course of the disease activity. In this multi-centre retrospective cohort study, data on 126 rheumatoid arthritis, 38 ankylosing spondylitis and 11 psoriatic arthritis patients were analysed, in whom biological therapies had been permanently discontinued. The reasons for the cessation of biologics, the DAS28 or BASDAI disease activity indices at the time of discontinuation and thereafter, and the subsequent occurrence of relapses and the duration of remission or low disease activity were investigated. The most common causes of discontinuation were adverse events (45%), inefficacy (16%) or remission (10%). In rheumatoid arthritis, 33.3% remained in low disease activity after a mean follow-up of 22 months. If the biologic was stopped when the disease was inactive, 60.6% remained inactive, and in all the patients in whom the biologic was discontinued because of long-standing remission, the disease remained inactive. Predictors of remission after discontinuation were low disease activity at stopping the biologic and shorter duration of biological therapy. In contrast, 50% of the ankylosing spondylitis patients relapsed after the withdrawal of anti-TNF therapy. Biologic-free low disease activity can be achieved in at least one third of rheumatoid arthritis patients, and low disease activity at the time of discontinuation is a strong predictor of a subsequent favourable disease course. The likelihood of continued remission after the cessation of a biological therapy is much lower in ankylosing spondylitis.
本研究旨在探讨炎症性风湿病患者永久性停止生物治疗的原因，并分析疾病活动度的后续病程。在这项多中心回顾性队列研究中，分析了 126 例类风湿关节炎、38 例强直性脊柱炎和 11 例银屑病关节炎患者的数据，这些患者的生物治疗已被永久性停止。研究了停止生物治疗的原因、停药时的 DAS28 或 BASDAI 疾病活动指数以及随后的复发情况、缓解持续时间或低疾病活动的发生。停止生物治疗的最常见原因是不良事件（45%）、无效（16%）或缓解（10%）。在类风湿关节炎中，33.3%的患者在平均 22 个月的随访后仍处于低疾病活动状态。如果在疾病无活动时停止使用生物制剂，60.6%的患者仍处于无活动状态，而所有因长期缓解而停止使用生物制剂的患者中，疾病仍处于无活动状态。停药后缓解的预测因素是停止生物治疗时疾病活动度低和生物治疗持续时间较短。相比之下，50%的强直性脊柱炎患者在停止 TNF 治疗后复发。至少三分之一的类风湿关节炎患者可以达到无生物制剂的低疾病活动状态，停药时的低疾病活动度是后续疾病进程良好的有力预测因素。在强直性脊柱炎中，停止生物治疗后继续缓解的可能性要低得多。
