Huynh D H, Boyd T A, Etzel C J, Cox V, Kremer J, Mease P, Kavanaugh A
Allergy and Rheumatology Clinic , La Jolla, California , USA.
Division of Rheumatology, Department of Medicine , Western University , London, Ontario , Canada.
RMD Open. 2017 Jan 16;3(1):e000395. doi: 10.1136/rmdopen-2016-000395. eCollection 2017.
To determine the duration of clinical benefit among patients with psoriatic arthritis (PsA) discontinuing tumour necrosis factor inhibitor (TNFi) therapy while in low disease activity (LDA), and to identify patient characteristics associated with prolonged clinical benefit.
We performed an observational cohort study assessing patients with PsA from the Consortium of Rheumatology Researchers of North America (CORRONA) registry who had discontinued TNFi after achieving LDA, defined as clinical disease activity index (CDAI) score ≤10 and physician's global assessment (PGA) of skin psoriasis ≤20/100. Kaplan-Meier method was used to estimate the duration of clinical benefit.
Of the 5945 patients with PsA in CORRONA, 302 patients had discontinued TNFi (n=325) while in LDA and had follow-up data available. At time of discontinuation, mean PsA duration was 9.8 years, mean CDAI was 3.9, and mean duration of TNFi use was 1.5 years; 52.6% of patients had discontinued their first TNFi. Median time to loss of benefit was 29.2 months. 179 (55.1%) patients had persistent benefit at their previous clinic visit. An increased risk of losing clinical benefit was seen among patients with higher disease activity at discontinuation (CDAI≥3.2 vs <3.2; HR 1.43 (p=0.32)) and among smokers (HR 1.78 (p=0.027)).
Patients with PsA who achieve LDA may maintain clinical benefit after discontinuation of TNFi therapy.
确定银屑病关节炎（PsA）患者在疾病低活动度（LDA）时停用肿瘤坏死因子抑制剂（TNFi）治疗后的临床获益持续时间，并确定与延长临床获益相关的患者特征。
我们进行了一项观察性队列研究，评估来自北美风湿病研究人员联盟（CORRONA）注册库的PsA患者，这些患者在达到LDA（定义为临床疾病活动指数（CDAI）评分≤10且医生对皮肤银屑病的整体评估（PGA）≤20/100）后停用了TNFi。采用Kaplan-Meier方法估计临床获益的持续时间。
在CORRONA的5945例PsA患者中，302例患者在LDA时停用了TNFi（n = 325）并可获得随访数据。停药时，PsA的平均病程为9.8年，平均CDAI为3.9，TNFi的平均使用时间为1.5年；52.6%的患者停用了他们的第一种TNFi。获益丧失的中位时间为29.2个月。179例（55.1%）患者在之前的门诊就诊时仍有持续获益。停药时疾病活动度较高的患者（CDAI≥3.2 vs <3.2；HR 1.43（p = 0.32））和吸烟者（HR 1.78（p = 0.027））丧失临床获益的风险增加。
达到LDA的PsA患者在停用TNFi治疗后可能维持临床获益。
