Levitsky Adrian, Wick Marius C, Möttönen Timo, Leirisalo-Repo Marjatta, Laasonen Leena, Korpela Markku, van Vollenhoven Ronald F, Rantalaiho Vappu
Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institutet, Stockholm, Sweden.
Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
Clin Exp Rheumatol. 2016 Nov-Dec;34(6):1065-1071. Epub 2016 Aug 31.
Predicted versus observed radiographic progression in early rheumatoid arthritis (POPeRA) was applied to demonstrate how various treatment modalities affect and potentially minimise radiographic progression over time.
The POPeRA method utilises the baseline radiographic score and patient-reported symptom duration to predict radiographic outcomes. It was applied at baseline, 2, and 5 years to patients with eRA from the randomised Finnish RA Combination trial (FIN-RACo) (n=144) and New Finnish RA Combination Therapy (NEO-RACo) (n=90) trials. For FIN-RACo, patients were randomised either to a single DMARD (sulfasalazine, with or without prednisolone) or to combination therapy (methotrexate+sulfasalazine+hydroxychloroquine, i.e. triple therapy, with prednisolone). In NEO-RACo, all patients were assigned intensified combination therapy (including 7.5 mg prednisolone/day) plus a randomised 6-month induction of either placebo or anti-TNF treatment (infliximab).
In FIN-RACo, combination versus monotherapy resulted in superior outcomes in the change from predicted progression over 2 and 5 years (mean 35.7% reduction vs. -32.9%, a worsening from predicted, p=0.001; 34.2% vs. -17.8%, p=0.003, respectively). In NEO-RACo, combination+anti-TNF induction led to significantly greater reductions from predicted progression than combination+placebo, both at 2 and 5 years of follow-up (98.5% vs. 83.4%, p=0.005; 92.4% vs. 82.5%, p=0.027, respectively). Importantly, anti-TNF add-on led to superior reductions from predicted among RF-positive patients (2 years: 97.4% vs. 80.4%, p=0.009; 5 years: 90.2% vs. 80.1%, p=0.030), but not among RF-negative patients.
These results confirm that conventional combination therapy in eRA has a long-term radiographic benefit versus monotherapy. Through POPeRA, it was made evident that anti-TNF induction therapy for 6 months further increases the long-term radiographic benefit of combination therapy in RF-positive patients.
应用早期类风湿关节炎的预测与观察到的影像学进展（POPeRA）来证明各种治疗方式如何随时间影响并潜在地最小化影像学进展。
POPeRA方法利用基线影像学评分和患者报告的症状持续时间来预测影像学结果。该方法在基线、2年和5年时应用于来自芬兰类风湿关节炎联合随机试验（FIN-RACo）（n = 144）和芬兰新类风湿关节炎联合治疗（NEO-RACo）（n = 90）试验的早期类风湿关节炎患者。对于FIN-RACo，患者被随机分配接受单一改善病情抗风湿药（柳氮磺胺吡啶，加或不加泼尼松龙）或联合治疗（甲氨蝶呤+柳氮磺胺吡啶+羟氯喹，即三联疗法，加泼尼松龙）。在NEO-RACo中，所有患者均接受强化联合治疗（包括每日7.5mg泼尼松龙）加随机6个月的安慰剂或抗TNF治疗（英夫利昔单抗）诱导。
在FIN-RACo中，联合治疗与单药治疗相比，在2年和5年的预测进展变化方面产生了更好的结果（平均降低35.7% vs. -32.9%，较预测值恶化，p = 0.001；34.2% vs. -17.8%，p = 0.003）。在NEO-RACo中，联合+抗TNF诱导在随访2年和5年时导致的预测进展降低均显著大于联合+安慰剂（分别为98.5% vs. 83.4%，p = 0.005；92.4% vs. 82.5%，p = 0.027）。重要的是，抗TNF附加治疗在RF阳性患者中导致的预测值降低更优（2年：97.4% vs. 80.4%，p = 0.009；5年：90.2% vs. 80.1%，p = 0.030），但在RF阴性患者中并非如此。
这些结果证实，早期类风湿关节炎的传统联合治疗与单药治疗相比具有长期影像学益处。通过POPeRA，很明显6个月的抗TNF诱导治疗进一步增加了联合治疗对RF阳性患者的长期影像学益处。
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