近期诊断的类风湿关节炎患者从目标治疗策略中获益:来自DREAM注册研究的结果
Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: results from the DREAM registry.
作者信息
Steunebrink Laura M M, Vonkeman Harald E, ten Klooster Peter M, Hoekstra Monique, van Riel Piet L C M, van de Laar Mart A F J
机构信息
Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA, Enschede, The Netherlands.
Department Psychology, Health & Technology, University of Twente, Enschede, The Netherlands.
出版信息
Clin Rheumatol. 2016 Mar;35(3):609-15. doi: 10.1007/s10067-016-3191-3. Epub 2016 Feb 6.
Despite considerable evidence on the efficacy and safety of early aggressive treat-to-target (T2T) strategies in early rheumatoid arthritis (RA), a proportion of patients still fail to reach remission. The goal of this study is to examine remission rates and predictors of remission in a real life T2T cohort of consecutive patients with a recent diagnosis of RA. Baseline demographics, clinical, laboratory and patient-reported variables and 1-year follow-up disease activity data were used from patients with early RA included in the DREAM remission induction cohort II study. Survival analyses and simple and multivariable logistic regression analyses were used to examine remission rates and significant predictors of achieving remission. A total of 137 recently diagnosed consecutive RA patients were available for this study. During the first year after inclusion, DAS28 remission was achieved at least once in 77.2 % of the patients and the median time to first remission was 17 weeks. None of the examined baseline variables were robustly associated with achieving remission within 1 year and in the multivariable analysis only lower ESR (p = 0.005) remained significantly associated with achieving fast remission within 17 weeks. During the first year of their disease a high proportion of recently diagnosed RA patient achieved remission, with only a small percentage of patients needing bDMARD therapy. Combined with the absence of baseline predictors of remission, this suggests that clinicians in daily clinical practice may focus on DAS28 scores only, without needing to take other patients characteristics into account.
尽管有大量证据表明早期积极治疗达标(T2T)策略在早期类风湿关节炎(RA)中的有效性和安全性,但仍有一部分患者未能达到缓解。本研究的目的是在一个近期诊断为RA的连续患者的真实生活T2T队列中,检查缓解率及缓解的预测因素。使用了DREAM缓解诱导队列II研究中纳入的早期RA患者的基线人口统计学、临床、实验室和患者报告变量以及1年随访疾病活动数据。采用生存分析以及单变量和多变量逻辑回归分析来检查缓解率和实现缓解的显著预测因素。本研究共有137例近期诊断的连续RA患者可供分析。在纳入后的第一年,77.2%的患者至少有一次达到DAS28缓解,首次缓解的中位时间为17周。所检查的基线变量均与1年内实现缓解没有稳健的关联,在多变量分析中,只有较低的红细胞沉降率(ESR)(p = 0.005)与在17周内实现快速缓解仍有显著关联。在疾病的第一年,很大一部分近期诊断的RA患者实现了缓解,只有一小部分患者需要生物改善病情抗风湿药物(bDMARD)治疗。结合缺乏缓解的基线预测因素,这表明临床医生在日常临床实践中可能仅关注DAS28评分,而无需考虑其他患者特征。