Ghent University Hospital and VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
Biostatistics Unit of the Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Arthritis Rheumatol. 2018 Nov;70(11):1769-1777. doi: 10.1002/art.40573.
New treatment algorithms using tumor necrosis factor (TNF) blockers in early stages of spondyloarthritis (SpA) induce high rates of clinical remission or low disease activity. It could be anticipated that such early intervention strategies in peripheral SpA may induce drug-free remission. We undertook this study to evaluate drug-free clinical remission after induction therapy with golimumab in patients with very early active peripheral SpA, and to identify patient characteristics that predict sustained drug-free remission.
Eligible patients were age ≥18 years and fulfilled the Assessment of SpondyloArthritis international Society criteria for peripheral SpA. All patients had symptom duration of <12 weeks. Sustained clinical remission was defined as the absence of arthritis, enthesitis, and dactylitis at 2 consecutive major visits, after which treatment was withdrawn. Patients were prospectively followed up to assess the rate of sustained drug-free clinical remission and clinical relapse.
Eighty-two percent of patients (49 of 60) fulfilled sustained clinical remission criteria after a regimen of induction therapy with golimumab. The majority of patients already reached this status at week 24 (n = 30), with an additional 11 and 8 patients at weeks 36 and 48, respectively. All patients had a follow-up period of at least 18 months after drug withdrawal. Fifty-three percent of patients (26 of 49) still have drug-free remission of their disease. Inability to sustain drug-free remission was associated with the presence of psoriasis and polyarticular disease (swollen joint count >5).
Anti-TNF treatment in very early peripheral SpA results in a remarkably high rate of sustained clinical remission. More than 50% of patients continue to have remission of their disease after withdrawal of therapy, which highlights a defined window of opportunity permitting induction of drug-free remission.
在脊柱关节炎（SpA）的早期阶段使用肿瘤坏死因子（TNF）阻滞剂的新治疗方案可诱导高比例的临床缓解或低疾病活动度。可以预期，外周型 SpA 的这种早期干预策略可能会诱导无药物缓解。我们进行这项研究是为了评估戈利木单抗诱导治疗对早期活动性外周型 SpA 患者的无药物临床缓解率，并确定预测持续无药物缓解的患者特征。
符合条件的患者年龄≥18 岁，符合外周 SpA 的评估 SpondyloArthritis 国际学会标准。所有患者的症状持续时间均<12 周。持续的临床缓解定义为在连续两次主要就诊时，关节炎、附着点炎和指（趾）炎均不存在，之后停止治疗。患者进行前瞻性随访，以评估持续无药物临床缓解和临床复发的发生率。
60 例患者中有 82%（49 例）符合戈利木单抗诱导治疗的持续临床缓解标准。大多数患者在第 24 周（n=30）时已经达到了这一状态，第 36 周和第 48 周时分别有 11 例和 8 例患者达到了这一状态。所有患者停药后至少有 18 个月的随访期。53%的患者（26 例）仍处于无药物疾病缓解状态。无法维持无药物缓解与存在银屑病和多关节病（肿胀关节数>5）有关。
在早期外周型 SpA 中使用抗 TNF 治疗可显著提高持续临床缓解率。超过 50%的患者在停止治疗后仍有疾病缓解，这突出了一个明确的机会窗口，可以诱导无药物缓解。
