Wabe Nasir, Wojciechowski Jessica, Wechalekar Mihir D, Cleland Leslie G, McWilliams Leah, Lee Anita, Proudman Susanna, Wiese Michael D
School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, Adelaide, South Australia, Australia.
Australian Centre for Pharmacometrics, University of South Australia, Adelaide, South Australia, Australia.
Int J Rheum Dis. 2017 Oct;20(10):1447-1456. doi: 10.1111/1756-185X.13184. Epub 2017 Sep 26.
To identify the disease activity trajectories during intensive triple disease modifying anti-rheumatic drug (DMARD) therapy over 3 years in rheumatoid arthritis (RA) patients and to evaluate the association with treatment persistence.
Disease Activity Score in 28 joints, baseline risk factors and medication usage were obtained from a longitudinal observational cohort of early RA patients, most of whom were treated with combination DMARD therapy consisting of methotrexate, sulfasalazine and hydroxychloroquine. Persistence of each DMARD was defined as the duration of time from initiation to cessation. A group-based trajectory modelling technique was used to identify disease activity trajectories.
Three disease activity trajectories (good [43.8%], moderate [39.7%] and poor [16.5%]) were identified in a cohort of 297 patients. Most baseline risk factors, medication usage, the rate of treatment persistence and the effect of persistence on disease activity differed among patients in each of the three trajectories. Although the rate of persistence was higher in the trajectory with a good outcome, the association with persistence was more pronounced among patients who were in the poor outcome trajectory. Persistence with at least two or all three baseline DMARDs was associated with a decrease in disease activity to a broadly similar degree in all trajectories.
After correction for other baseline prognostic factors, persistence with initial DMARDs contributes to heterogeneity in disease activity trajectory and there was an association between persistence with initial DMARD therapy and lower long-term disease activity.
确定类风湿关节炎（RA）患者在3年强化三联改善病情抗风湿药物（DMARD）治疗期间的疾病活动轨迹，并评估其与治疗持续性的关联。
从早期RA患者的纵向观察队列中获取28个关节的疾病活动评分、基线危险因素和用药情况，这些患者大多接受了由甲氨蝶呤、柳氮磺吡啶和羟氯喹组成的联合DMARD治疗。每种DMARD的持续性定义为从开始使用到停药的时间。采用基于组的轨迹建模技术来确定疾病活动轨迹。
在297例患者队列中确定了三种疾病活动轨迹（良好[43.8%]、中度[39.7%]和差[16.5%]）。三种轨迹中的患者在大多数基线危险因素、用药情况、治疗持续性率以及持续性对疾病活动的影响方面存在差异。虽然良好结局轨迹中的持续性率较高，但在差结局轨迹的患者中，与持续性的关联更为明显。在所有轨迹中，持续使用至少两种或全部三种基线DMARD与疾病活动度降低的程度大致相似。
在校正其他基线预后因素后，初始DMARD的持续性导致疾病活动轨迹的异质性，并且初始DMARD治疗的持续性与较低的长期疾病活动度之间存在关联。
