Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria.
Rheumatology (Oxford). 2020 Feb 1;59(2):324-334. doi: 10.1093/rheumatology/kez278.
To systematically review possible predictors of successful discontinuation of biologic or targeted synthetic DMARDs (b/tsDMARDs) in RA patients in remission or low disease activity.
MEDLINE database and Cochrane Library were scanned for studies that discontinued b/tsDMARDs in remission/low disease activity and searched for predictors of successful discontinuation. Additionally, EULAR and ACR meeting abstracts were hand searched.
Thirty-four studies with a total of 5724 patients were included. Predictors of successful b/tsDMARD discontinuation were (number of studies): low disease activity (n = 13), better physical function (n = 6), low or absence of rheumatoid factor (n = 5) or ACPA (n = 3), low levels of CRP (n = 3) or ESR (n = 3), shorter disease duration (n = 3), low signals of disease activity by ultrasound (n = 3). Only one study with high risk of bias was identified on tsDMARD discontinuation.
Several predictors of successful bDMARD discontinuation were identified. Although studies are heterogeneous, these predictors may inform clinical decision making in patients who are considered for a potential bDMARD discontinuation.
系统综述缓解或低疾病活动期 RA 患者成功停用生物制剂或靶向合成 DMARDs（b/tsDMARDs）的可能预测因素。
扫描 MEDLINE 数据库和 Cochrane 图书馆中关于缓解/低疾病活动期停用 b/tsDMARDs 的研究，并搜索成功停药的预测因素。此外，还对 EULAR 和 ACR 会议摘要进行了手工搜索。
共纳入 34 项研究，总计 5724 例患者。成功停用 b/tsDMARDs 的预测因素包括：低疾病活动度（n=13）、更好的身体功能（n=6）、低或无类风湿因子（n=5）或 ACPA（n=3）、CRP（n=3）或 ESR（n=3）水平低、疾病持续时间短（n=3）、超声显示疾病活动度低（n=3）。仅在一项 tsDMARD 停药的高偏倚风险研究中确定了一个预测因素。
确定了几个成功停用 bDMARDs 的预测因素。尽管研究存在异质性，但这些预测因素可以为考虑潜在 bDMARD 停药的患者提供临床决策依据。
