Department of Rheumatology, Leiden University Medical Center, Leiden.
Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Amsterdam.
Rheumatology (Oxford). 2017 Oct 1;56(10):1721-1728. doi: 10.1093/rheumatology/kex236.
To compare 10-year disease outcomes of RA patients who have continuous low disease activity and are on MTX with or without initial combination therapy with infliximab or prednisone and SSZ.
Recent-onset RA patients from the Behandel Strategieen (BeSt) (Dutch acronym for Treatment Strategies) study with 10 years of follow-up were analysed. Treatment was tightly controlled, targeted at DAS ⩽ 2.4. The selected patients had low disease activity from 6 months until 10 years and therefore did not intensify treatment. Patients were grouped into those receiving MTX monotherapy and those receiving initial combination therapy. Between-group differences over time were compared, using (generalized) linear mixed model analyses, for the outcomes DAS, HAQ, ESR, visual analogue scale patient global health, percentage of patients in (drug-free) remission and percentage of patients with Sharp/van der Heijde score progression ⩾5.
At 10 years, 28/247 (11%) patients on MTX monotherapy (some tapered to drug free) had continued DAS ⩽ 2.4 compared with 68/261 (26%) patients on combination therapy (all tapered to monotherapy or drug free). No between-group differences in continuous responders were found over time, except for a higher percentage of patients in drug-free remission after MTX monotherapy. Significant group-time interactions were found for DAS, ESR and visual analogue scale patient global health, but the results seem clinically negligible.
More patients achieved continuous low disease activity on initial prednisone or infliximab combination therapy than on initial MTX monotherapy, but there appeared to be no additional benefits. Regardless of induction therapy, patients with continuous low disease activity have similar long-term outcomes, with only a higher proportion of patients in drug-free remission after MTX monotherapy.
比较持续低疾病活动且接受甲氨蝶呤（MTX）治疗、初始联合治疗（包括英夫利昔单抗或泼尼松和柳氮磺胺吡啶）的 RA 患者 10 年的疾病结局。
对 Behandel Strategieen（BeSt）研究中具有 10 年随访的新发 RA 患者进行分析。治疗严格控制，目标是 DAS ⩽ 2.4。选择的患者在 6 个月至 10 年内疾病活动度低，因此未强化治疗。将患者分为接受 MTX 单药治疗和初始联合治疗的两组。使用（广义）线性混合模型分析比较两组间的差异，评估结局包括 DAS、HAQ、ESR、患者整体健康视觉模拟评分、（无药物）缓解患者比例和 Sharp/van der Heijde 评分进展 ⩾5 的患者比例。
在 10 年时，28/247（11%）接受 MTX 单药治疗（部分患者逐渐停药至无药物）的患者 DAS ⩽ 2.4，而 68/261（26%）接受联合治疗（所有患者逐渐减至单药或无药物）的患者 DAS ⩽ 2.4。除 MTX 单药治疗后无药物缓解的患者比例更高外，两组间连续应答者比例无随时间变化的差异。DAS、ESR 和患者整体健康视觉模拟评分存在显著的组间时间交互作用，但结果似乎具有临床意义。
与初始 MTX 单药治疗相比，初始泼尼松或英夫利昔单抗联合治疗的患者有更多的患者实现持续低疾病活动，但似乎没有额外的益处。无论诱导治疗如何，持续低疾病活动的患者具有相似的长期结局，仅 MTX 单药治疗后无药物缓解的患者比例更高。
