Norvang Vibeke, Brinkmann Gina H, Yoshida Kazuki, Lillegraven Siri, Aga Anna-Birgitte, Sexton Joseph, Tedeschi Sara K, Lyu Houchen, Norli Ellen S, Uhlig Till, Kvien Tore K, Mjaavatten Maria D, Solomon Daniel H, Haavardsholm Espen A
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Arthritis Rheumatol. 2020 Feb 23. doi: 10.1002/art.41232.
To compare achievement of remission in two early rheumatoid arthritis (RA) treat-to-target (TTT) cohorts, one tight control cohort targeting stringent remission in a randomized controlled strategy trial and one observational cohort targeting a looser definition of remission in clinical practice.
We analyzed data from the ARCTIC trial and the NOR-VEAC observational study. Both were Norwegian multicenter studies including disease modifying anti-rheumatic drug (DMARD)-naïve RA-patients and implementing TTT. The target in ARCTIC was remission defined as a Disease Activity Score (DAS44) <1.6 plus 0 of 44 swollen joint count, while the target in NOR-VEAC was the less stringent remission of DAS28<2.6. We assessed achievement of the study-specific targets and compared achievement of the ACR/ EULAR Boolean remission during two years of follow-up.
We included 189 patients from ARCTIC and 330 patients from NOR-VEAC. More than half in each cohort had reached the study-specific target at 6 months, increasing to more than 60% at 12 and 24 months. The odds of reaching ACR/EULAR Boolean remission during follow-up were higher in ARCTIC than in NOR-VEAC, with statistically significant differences at 3 months (OR 1.73; 95% CI 1.03-2.89), 12 months (OR 1.97; 95% CI 1.21-3.20) and 24 months (OR 1.82; 95% CI 1.05 - 3.16).
A majority of patients in both cohorts reached the study-specific treatment targets. More patients in ARCTIC than in NOR-VEAC achieved ACR/EULAR Boolean remission during follow-up, suggesting that targeting a more stringent definition of remission provide further potential for favorable outcomes of a TTT strategy.
比较两个早期类风湿关节炎（RA）治疗达标（TTT）队列的缓解情况，一个是在随机对照策略试验中以严格缓解为目标的严格控制队列，另一个是在临床实践中以较宽松缓解定义为目标的观察性队列。
我们分析了北极试验和挪威关节炎注册与质量评估（NOR-VEAC）观察性研究的数据。两者均为挪威多中心研究，纳入初治类风湿关节炎患者并实施治疗达标。北极试验的目标缓解定义为疾病活动评分（DAS44）<1.6且44个肿胀关节计数为0，而NOR-VEAC的目标是较宽松的DAS28<2.6缓解。我们评估了特定研究目标的达成情况，并比较了随访两年期间美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）布尔值缓解的达成情况。
我们纳入了189例北极试验患者和330例NOR-VEAC患者。每个队列中超过一半的患者在6个月时达到了特定研究目标，在12个月和24个月时增至60%以上。随访期间达到ACR/EULAR布尔值缓解的几率在北极试验中高于NOR-VEAC，在3个月（比值比[OR]1.73；95%置信区间[CI]1.03 - 2.89）、12个月（OR 1.97；95%CI 1.21 - 3.20）和24个月（OR 1.82；95%CI 1.05 - 3.16）时有统计学显著差异。
两个队列中的大多数患者达到了特定研究治疗目标。随访期间，北极试验中实现ACR/EULAR布尔值缓解的患者比NOR-VEAC多，这表明针对更严格的缓解定义为治疗达标策略的良好结局提供了进一步的潜在可能。
