Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No.1 Shuaifuyuan, Wangfujing Ave., Beijing, 100730, China.
Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
Clin Rheumatol. 2019 Mar;38(3):727-738. doi: 10.1007/s10067-018-4340-7. Epub 2018 Oct 19.
This systematic review and meta-analysis aim to evaluate the remission rate of patients with rheumatoid arthritis (RA) in real-world studies and to summarize potential predictors of remission in RA. Studies reporting remission rate in patients with RA were searched from MEDLINE, EMBASE, and Scopus databases. Two reviewers independently assessed all studies according to eligibility criteria and extracted data. Generally, observational studies reporting remission rate in adult (≥ 18 years) patients with RA were included. Quality assessments were performed using the Newcastle-Ottawa Scale. Pooled analyses of remission rate were conducted using a random-effects model and data were analyzed in subgroups to identify potential source of heterogeneity. Sensitivity analyses were performed by serially excluding each study. Potential predictors of remission were summarized. Thirty-one studies with ~ 82,450 RA patients in total were included. Using the DAS28 remission criteria, the pooled 3-, 6-, 12-, and 24-month remission rates were 17.2%, 16.3%, 21.5%, and 23.5%, respectively. Subgroup analyses showed that 11.7% and 13.8% of TNFi inadequate responders reached remission after 6- and 12-month use of non-TNFi biologics. Predictors of remission included male, higher education level, and lower baseline disease activity, while initial use of corticosteroids was negative predictors of remission. Sustained remission was rare regardless of different criteria used. Remission was a reachable target in real-world studies, while attention should also be paid to achieve sustained remission.
本系统评价和荟萃分析旨在评估真实世界研究中类风湿关节炎(RA)患者的缓解率,并总结 RA 缓解的潜在预测因素。从 MEDLINE、EMBASE 和 Scopus 数据库中检索报告 RA 患者缓解率的研究。两名审查员根据入选标准独立评估所有研究并提取数据。一般来说,纳入了报告成人(≥18 岁)RA 患者缓解率的观察性研究。使用纽卡斯尔-渥太华量表进行质量评估。使用随机效应模型进行缓解率的汇总分析,并进行亚组分析以确定潜在的异质性来源。通过连续排除每项研究进行敏感性分析。总结了缓解的潜在预测因素。共纳入 31 项研究,总计约 82450 例 RA 患者。使用 DAS28 缓解标准,汇总的 3、6、12 和 24 个月缓解率分别为 17.2%、16.3%、21.5%和 23.5%。亚组分析显示,11.7%和 13.8%的 TNFi 应答不足患者在使用非 TNFi 生物制剂 6 个月和 12 个月后达到缓解。缓解的预测因素包括男性、较高的教育水平和较低的基线疾病活动度,而初始使用皮质类固醇是缓解的负面预测因素。无论使用何种标准,缓解的持续时间都很少见。缓解是真实世界研究中可以达到的目标,但也应注意实现持续缓解。
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