The Parker Institute and Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, and Gentofte Hospital, Hellerup, Denmark.
The Parker Institute and Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, and Gentofte Hospital, Hellerup, and DANBIO Registry and Rigshospitalet, Glostrup, Denmark.
Arthritis Care Res (Hoboken). 2018 Apr;70(4):592-599. doi: 10.1002/acr.23333. Epub 2018 Mar 7.
The objective of this population-based cohort study was to investigate the impact of comorbidities on disease activity, treatment response, and persistence with the first-tried tumor necrosis factor inhibitor (TNFi) in patients with psoriatic arthritis (PsA).
Data on patient characteristics, disease activity, and treatment response and persistence were obtained from the DANBIO registry. Information on comorbidities according to the Charlson Comorbidity Index (CCI) was obtained through linkage with the Danish National Patient Register. Kaplan-Meier plots and Cox proportional hazard regression analyses were performed. Percentages of patients achieving relevant clinical responses were calculated.
We identified 1,750 patients eligible for analyses. Patients with higher CCI scores had higher disease activity measures at baseline and increased occurrence of depression and/or anxiety. Kaplan-Meier curves showed shorter persistence with treatment for patients with a CCI score ≥2 (log-rank P < 0.001) and for patients with depression and/or anxiety (P = 0.027) compared to patients without comorbidities. In multivariate analysis, a CCI score ≥2 was associated with reduced TNFi persistence compared with patients without comorbidities (hazard ratio 1.72 [95% confidence interval 1.26-2.37]; P = 0.001). A smaller proportion of patients with a CCI score ≥2 achieved European League Against Rheumatism (EULAR) good response (P < 0.001) and EULAR good-or-moderate response (P < 0.001) at 6 months compared with patients without comorbidities.
The presence of comorbidities was associated with higher baseline disease activity, shorter TNFi persistence, and reduced clinical response rates in a cohort of Danish patients with PsA.
本基于人群的队列研究旨在探讨共病对银屑病关节炎（PsA）患者疾病活动度、治疗反应和首次尝试肿瘤坏死因子抑制剂（TNFi）治疗的持续性的影响。
从 DANBIO 登记处获得了患者特征、疾病活动度和治疗反应及持续性的数据。通过与丹麦国家患者登记处的链接获得了 Charlson 合并症指数（CCI）的共病信息。进行了 Kaplan-Meier 图和 Cox 比例风险回归分析。计算了达到相关临床反应的患者百分比。
我们确定了 1750 名符合分析条件的患者。CCI 评分较高的患者基线时疾病活动度较高，且抑郁和/或焦虑的发生率增加。Kaplan-Meier 曲线显示，CCI 评分≥2 的患者（对数秩 P < 0.001）和有抑郁和/或焦虑的患者（P = 0.027）的治疗持续时间短于无共病的患者。多变量分析显示，与无共病的患者相比，CCI 评分≥2 与 TNFi 持续性降低相关（风险比 1.72 [95%置信区间 1.26-2.37]；P = 0.001）。CCI 评分≥2 的患者在 6 个月时达到欧洲抗风湿病联盟（EULAR）良好反应（P < 0.001）和 EULAR 良好或中度反应的比例较小（P < 0.001），与无共病的患者相比。
在丹麦队列中，患有共病的银屑病关节炎患者的基线疾病活动度更高，TNFi 持续性更短，临床反应率降低。
