Rheumatology Unit, Department of Emergence and Transplantation (DETO), University of Bari, Bari, Italy.
Eur J Clin Invest. 2021 Feb;51(2):e13363. doi: 10.1111/eci.13363. Epub 2020 Sep 25.
Little is known about possible predictors of long-term survival on biologic disease-modifying antirheumatic drugs (bDMARD) after achievement of deep clinical remission in rheumatoid arthritis (RA) patients. We aimed at assessing factors associated with drug persistence of the first bDMARD in RA patients who achieved Simplified Disease Activity Index (SDAI) remission.
The clinical charts of RA patients beginning a first bDMARD were retrospectively reviewed, and those who achieved SDAI-based remission were selected for this analysis. Drug retention rate and mean survival time (MST) were estimated using Kaplan-Meier curves, and hazard ratios (HRs) of discontinuing bDMARD were estimated by multivariate Cox-regression models.
Eight-six patients were on SDAI remission, and the survival rate of bDMARDs since 'baseline-time' was 82.6% (MST = 77.8 (95% CI: 69-86) months). Once on remission, patients not taking concomitant glucocorticoids had significantly higher survival rate (90.7%, MST = 86.3 (95% CI: 78-95) months) than patients who continued to intake low dose of glucocorticoids (68.8%, MST = 56.9 (95% CI: 45-69) months; P = .008). On the contrary, those patients assuming methotrexate (MTX) had significantly higher survival (87.7% (MST = 81.8 (95% CI: 73-91) months) than patients who were not taking MTX (66.7% (MST = 55.3 (95% CI: 40-71) months) (log-rank 4.72, P = .03). After the achievement of disease remission, stopping glucocorticoids (HR 0.31, 95% CI: 0.10-0.93) and methotrexate co-therapy (HR 0.34, 95% CI: 0.12-0.98) were independently associated with a lower risk of bDMARD discontinuation.
Among RA patients on clinical remission with a first bDMARD, those stopping glucocorticoids and continuing MTX had much longer survival on bDMARD.
在类风湿关节炎（RA）患者达到深度临床缓解后，对于生物改善病情抗风湿药物（bDMARD）长期生存的可能预测因素知之甚少。我们旨在评估达到简化疾病活动指数（SDAI）缓解的 RA 患者中，首个 bDMARD 药物持续存在的相关因素。
回顾性分析开始使用首个 bDMARD 的 RA 患者的临床病历，并选择达到 SDAI 缓解的患者进行此分析。使用 Kaplan-Meier 曲线估计药物保留率和平均生存时间（MST），并通过多变量 Cox 回归模型估计停止 bDMARD 的风险比（HR）。
86 例患者达到 SDAI 缓解，自“基线时间”起 bDMARD 的生存率为 82.6%（MST=77.8（95%CI：69-86）个月）。一旦缓解，不服用同时使用糖皮质激素的患者的生存率显著高于继续服用低剂量糖皮质激素的患者（90.7%，MST=86.3（95%CI：78-95）个月）；P=0.008）。相反，那些接受甲氨蝶呤（MTX）治疗的患者的生存率明显更高（87.7%（MST=81.8（95%CI：73-91）个月），而未接受 MTX 治疗的患者的生存率为 66.7%（MST=55.3（95%CI：40-71）个月）（对数秩检验 4.72，P=0.03）。在疾病缓解后，停止使用糖皮质激素（HR 0.31，95%CI：0.10-0.93）和甲氨蝶呤联合治疗（HR 0.34，95%CI：0.12-0.98）与 bDMARD 停药风险降低独立相关。
在达到临床缓解的首个 bDMARD 的 RA 患者中，停止使用糖皮质激素并继续使用 MTX 的患者的 bDMARD 生存时间更长。
