Rheumatology, Cliniques universitaires Saint-Luc - Université catholique de Louvain - Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium.
Arthritis Res Ther. 2020 Apr 28;22(1):96. doi: 10.1186/s13075-020-02165-4.
BACKGROUND/PURPOSE: Studies have demonstrated that rheumatoid arthritis (RA) patients who achieve low disease activity or remission are able to taper biological disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to evaluate the proportion of patients in whom bDMARDs can be tapered in daily practice and to analyse the characteristics of these patients. Other objectives were to analyse which bDMARDs are more suitable for dose reduction and the cost savings.
Data from 332 eligible RA patients from our Brussels UCLouvain cohort were retrospectively analysed; 140 patients (42.1%) received a tapered regimen, and 192 received stable doses of bDMARDs. The age at diagnosis (43.1 vs 38.7 years, p = 0.04), health assessment questionnaire (HAQ) score (1.3 vs 1.5, p = 0.048), RF positivity rate (83.3 vs 72.9%, p = 0.04) and disease duration at the time of bDMARD introduction (9.7 vs 12.1 years, p = 0.034) were significantly different between the reduced-dose and stable-dose groups. Interestingly, relatively more patients receiving a tapered dose were treated with a combination of bDMARDs and methotrexate (MTX) (86.7% vs 73.8%, p = 0.005). In our cohort, anti-TNF agents were the most commonly prescribed medications (68%). Only 15 patients experienced a flare during follow-up. Adalimumab, etanercept and rituximab were the most common bDMARDs in the reduced-dose group and were associated with the most important reductions in annual cost.
In daily practice, tapering bDMARDs in RA patients who have achieved low disease activity or remission is an achievable goal in a large proportion of patients, thereby reducing potential side effects and annual drug-associated costs. The combination of bDMARDs with MTX could improve the success of dose reduction attempts.
This retrospective non-interventional study was retrospectively registered with local ethics approval.
背景/目的：研究表明，类风湿关节炎（RA）患者达到低疾病活动度或缓解后，可以逐渐减少生物疾病修饰抗风湿药物（bDMARDs）的剂量。本研究的目的是评估在日常实践中可以减少 bDMARDs 剂量的患者比例，并分析这些患者的特征。其他目的是分析哪些 bDMARDs 更适合减少剂量以及节省成本。
我们对来自布鲁塞尔 UCLouvain 队列的 332 名符合条件的 RA 患者进行了回顾性分析；140 名患者（42.1%）接受了减量治疗方案，192 名患者接受了 bDMARDs 的稳定剂量。诊断时的年龄（43.1 岁比 38.7 岁，p=0.04）、健康评估问卷（HAQ）评分（1.3 比 1.5，p=0.048）、RF 阳性率（83.3%比 72.9%，p=0.04）和 bDMARD 引入时的疾病持续时间（9.7 年比 12.1 年，p=0.034）在减量组和稳定剂量组之间存在显著差异。有趣的是，接受减量剂量的患者中，接受 bDMARD 联合甲氨蝶呤（MTX）治疗的比例相对较高（86.7%比 73.8%，p=0.005）。在我们的队列中，抗 TNF 药物是最常用的药物（68%）。只有 15 名患者在随访期间出现了疾病复发。在减量组中，阿达木单抗、依那西普和利妥昔单抗是最常见的 bDMARDs，与年度成本的最重要降低相关。
在日常实践中，对于已经达到低疾病活动度或缓解的 RA 患者，逐渐减少 bDMARDs 的剂量是大多数患者可以实现的目标，从而降低潜在的副作用和与药物相关的年度成本。bDMARDs 联合 MTX 可以提高减少剂量尝试的成功率。
这项回顾性非干预性研究在获得当地伦理委员会批准后进行了回顾性注册。
