Akdemir Gülşah, Markusse Iris M, Bergstra Sytske Anne, Goekoop Robbert J, Molenaar Esmeralda T, van Groenendael Johannes H L M, Kerstens Pit J S M, Lems Willem F, Huizinga Tom W J, Allaart Cornelia F
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Rheumatology, Haga Hospital, The Hague, The Netherlands.
RMD Open. 2018 May 20;4(1):e000649. doi: 10.1136/rmdopen-2018-000649. eCollection 2018.
To compare outcomes of targeted treatment aimed at either low disease activity or remission in patients with early active rheumatoid arthritis (RA).
Five-year outcomes were compared in 133 patients with early active RA (1987), starting with methotrexate, sulfasalazine and tapered high dose of prednisone (arm 3 of the BehandelStrategieën (Treatment Strategies for Rheumatoid Arthritis) (BeSt) study), targeted at Disease Activity Score (DAS) ≤2.4 (low disease activity), and 175 patients with early RA, starting methotrexate and tapered high dose of prednisone, targeted at DAS <1.6 (selected from IMPROVED study who would have fulfilled inclusion criteria of the BeSt study). Association of treatment target with outcomes DAS <1.6, Boolean remission at year 1 and drug-free DAS remission (DFR) at year 5 were analysed by logistic regression analysis.
At baseline, DAS <1.6 steered patients had a milder disease than DAS ≤2.4 steered patients (mean DAS 4.1±SD 0.7vs4.4±0.9, p=0.012) and less radiological damage. DAS decrease, functional ability and radiological damage progression over time were similar in both patient groups. DAS ≤2.4 was achieved in similar percentages in both patient groups, but more DAS <1.6 steered patients achieved DAS <1.6 and DFR. DAS <1.6 steered treatment was associated with achieving DAS <1.6 (OR 3.04 (95% CI 1.64 to 5.62)) and Boolean remission (3.03 (1.45 to 6.33)) at year 1 and DFR at year 5 (3.77 (1.51 to 9.43)).
In patients with early active RA who start with comparable disease-modifying antirheumatic drug+prednisone combination therapy, subsequent DAS <1.6 steered treatment is associated with similar clinical and radiological outcomes over time as DAS ≤2.4 steered treatment; however, in the DAS <1.6 steered group, more patients achieved remission and drug-free remission.
比较针对早期活动类风湿关节炎（RA）患者低疾病活动度或缓解状态的靶向治疗效果。
对133例早期活动RA（1987年）患者的五年治疗效果进行比较，这些患者起始接受甲氨蝶呤、柳氮磺胺吡啶及逐渐减量的高剂量泼尼松治疗（类风湿关节炎治疗策略（BeSt）研究的第3组），治疗目标为疾病活动度评分（DAS）≤2.4（低疾病活动度）；另175例早期RA患者，起始接受甲氨蝶呤和逐渐减量的高剂量泼尼松治疗，治疗目标为DAS<1.6（从IMPROVED研究中选取符合BeSt研究纳入标准的患者）。通过逻辑回归分析治疗目标与DAS<1.6、第1年的布尔值缓解及第5年的无药DAS缓解（DFR）等结局的相关性。
基线时，DAS<1.6导向组患者的病情比DAS≤2.4导向组患者更轻（平均DAS 4.1±标准差0.7对4.4±0.9，p=0.012），且放射学损伤更少。两组患者随时间推移的DAS降低、功能能力及放射学损伤进展相似。两组患者达到DAS≤2.4的百分比相似，但更多DAS<1.6导向组患者达到DAS<1.6及DFR。DAS<1.6导向治疗与第1年达到DAS<1.6（比值比3.04（95%可信区间1.64至5.62））、布尔值缓解（3.03（1.45至6.33））及第5年的DFR（3.77（1.51至9.43））相关。
对于起始接受类似改善病情抗风湿药物+泼尼松联合治疗的早期活动RA患者，随后DAS<1.6导向治疗与DAS≤2.4导向治疗随时间推移具有相似的临床和放射学结局；然而，在DAS<1.6导向组中，更多患者实现了缓解和无药缓解。
