类风湿关节炎中性别相关治疗差异及其结局：来自 METEOR 登记研究的结果。

Sex-associated Treatment Differences and Their Outcomes in Rheumatoid Arthritis: Results from the METEOR Register.

机构信息

From the Leiden University Medical Center (LUMC), Leiden; Amsterdam Rheumatology and Immunology Center, Amsterdam; Zuyderland Medical Center, Heerlen, the Netherlands; Center for Rheumatic Diseases, Pune, India; University of the Witwatersrand, Johannesburg, South Africa; Instituto Português de Reumatologia, Lisbon, Portugal; Wishaw General Hospital, Wishaw, Lanarkshire, UK.

S.A. Bergstra, MSc, LUMC; C.F. Allaart, MD, PhD, LUMC; S. Ramiro, MD, PhD, LUMC; A. Chopra, MD, PhD, Center for Rheumatic Diseases; N. Govind, MD, University of the Witwatersrand; C. Silva, MD, Instituto Português de Reumatologia; E.A. Murphy, MD, Wishaw General Hospital; R.B. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center, and Zuyderland Medical Center.

出版信息

J Rheumatol. 2018 Oct;45(10):1361-1366. doi: 10.3899/jrheum.171176. Epub 2018 Jun 15.

DOI:10.3899/jrheum.171176

PMID:29907672

Abstract

OBJECTIVE

To assess differences in initial treatment and treatment response in male and female patients with rheumatoid arthritis (RA) in daily clinical practice.

METHODS

The proportion of patients with RA starting different antirheumatic treatments (disease-modifying antirheumatic drugs; DMARD) and the response to treatment were compared in the international, observational METEOR register. All visits from start of the first DMARD until the first DMARD switch or the end of followup were selected. The effect of sex on time to switch from first to second treatment was calculated using Cox regression. Linear mixed model analyses were performed to assess whether men and women responded differently to treatments, as measured by Disease Activity Score (DAS) or Health Assessment Questionnaire.

RESULTS

Women (n = 4393) more often started treatment with hydroxychloroquine, as monotherapy or in combination with methotrexate (MTX) or a glucocorticoid, and men (n = 1142) more often started treatment with MTX and/or sulfasalazine. Time to switch DMARD was shorter for women than for men. Women had a statistically significantly higher DAS over time than men (DAS improvement per year β -0.69, 95% CI -0.75 to -0.62 for men and -0.58, 95% CI -0.62 to -0.55 for women). Subanalyses per DMARD group showed for the conventional synthetic DMARD combination therapy a slightly greater decrease in DAS over time in men (-0.89, 95% CI -1.07 to -0.71) compared to women (-0.59, 95% CI -0.67 to -0.51), but these difference between the sexes were clinically negligible.

CONCLUSION

This worldwide observational study suggests that in daily practice, men and women with RA are prescribed different initial treatments, but there were no differences in response to treatment between the sexes.

摘要

目的

评估在日常临床实践中，男性和女性类风湿关节炎（RA）患者初始治疗和治疗反应的差异。

方法

在国际观察性 METEOR 登记处，比较了开始使用不同抗风湿治疗（疾病修饰抗风湿药物；DMARD）的 RA 患者比例和治疗反应。选择从开始使用第一种 DMARD 到第一次 DMARD 转换或随访结束的所有就诊情况。使用 Cox 回归计算性别对从第一种治疗转换为第二种治疗的时间的影响。采用线性混合模型分析评估男性和女性对治疗的反应是否不同，以疾病活动评分（DAS）或健康评估问卷（HAQ）衡量。

结果

女性（n=4393）更常开始使用羟氯喹单药治疗或与甲氨蝶呤（MTX）或糖皮质激素联合治疗，而男性（n=1142）更常开始使用 MTX 和/或柳氮磺胺吡啶治疗。女性的 DMARD 转换时间短于男性。与男性相比，女性随时间推移 DAS 更高（男性 DAS 改善每年β-0.69，95%CI-0.75 至-0.62，女性β-0.58，95%CI-0.62 至-0.55）。DMARD 组的亚分析显示，对于传统合成 DMARD 联合治疗，男性 DAS 随时间的下降幅度略高于女性（-0.89，95%CI-1.07 至-0.71），但两性之间的差异在临床上可以忽略不计。