Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, Tokyo, Japan.
Division of Natural Medicine and Therapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, Tokyo, Japan.
Clin Rheumatol. 2021 Jul;40(7):2657-2663. doi: 10.1007/s10067-021-05599-6. Epub 2021 Jan 22.
We investigated factors predicting the addition of disease-modifying antirheumatic drugs (DMARDs) after an initial methotrexate (MTX) monotherapy in rheumatoid arthritis (RA) patients to support an early decision on the DMARDs addition.
This retrospective cohort study included 311 patients who were diagnosed with RA and started on MTX monotherapy at Showa University Hospital, Japan. The outcome was addition of DMARDs after an initial MTX monotherapy at 6 months. Baseline patient characteristics were compared between the DMARDs addition and MTX monotherapy continuation groups, and significant independent predictive factors for the addition of DMARDs were selected using multivariate analysis.
The median age of patients was 62 years (range 24-90), 170 patients (73%) were women, the median swollen 28-joint count (SJC28) was 3 (0-28), and the median tender 28-joint count (TJC28) was 5 (0-28). DMARDs were added in 65 (27.9%) patients. In the univariate analysis, higher TJC28 and SJC28, concomitant use of nonsteroidal anti-inflammatory drugs, and intra-articular glucocorticoid (GC) injection history were significantly associated with the DMARDs addition. In the multivariate analysis, by adding covariates to the variables identified in the univariate analysis, SJC28 (odds ratio [OR] 1.390 per 5 joints increase; 95% confidence interval [CI], 1.036-1.866) and intra-articular GC injection history (OR 3.678; 95% CI, 1.170-11.557) were independent predictors of DMARDs addition.
A higher SJC28 and intra-articular GC injection history may be useful predictors of DMARDs addition after the initial MTX monotherapy. We expect that using these predictors will enable an earlier shift to a more aggressive treatment. Key Points ・We performed a retrospective cohort study with the addition of DMARDs as the outcome in patients with RA who were started on MTX monotherapy. ・A higher SJC28 (OR 1.390; 95% CI, 1.036-1.866) and an intra-articular GC injection history (OR 3.678; 95% CI, 1.170-11.557) may be useful predictors for the addition of DMARDs of initiating MTX monotherapy at 6 months. ・The use of such indicators may support an early decision on the addition of DMARDs after the initial MTX monotherapy.
我们研究了预测类风湿关节炎（RA）患者初始甲氨蝶呤（MTX）单药治疗后添加疾病修饰抗风湿药物（DMARDs）的因素，以支持早期决定添加 DMARDs。
本回顾性队列研究纳入了 311 名在日本昭和大学医院诊断为 RA 并开始 MTX 单药治疗的患者。结局为初始 MTX 单药治疗 6 个月后添加 DMARDs。比较 DMARDs 添加组和 MTX 单药持续组的基线患者特征，并使用多变量分析选择 DMARDs 添加的显著独立预测因素。
患者的中位年龄为 62 岁（范围 24-90），170 名患者（73%）为女性，中位肿胀 28 关节计数（SJC28）为 3（0-28），中位压痛 28 关节计数（TJC28）为 5（0-28）。65 名（27.9%）患者添加了 DMARDs。单因素分析中，TJC28 和 SJC28 较高、同时使用非甾体抗炎药和关节内糖皮质激素（GC）注射史与 DMARDs 添加显著相关。多因素分析中，通过向单因素分析中确定的变量添加协变量，SJC28（每增加 5 个关节的优势比[OR]1.390；95%置信区间[CI]，1.036-1.866）和关节内 GC 注射史（OR 3.678；95% CI，1.170-11.557）是 DMARDs 添加的独立预测因素。
SJC28 较高和关节内 GC 注射史可能是初始 MTX 单药治疗后添加 DMARDs 的有用预测指标。我们期望使用这些预测指标能够更早地转向更积极的治疗。关键点：·我们进行了一项回顾性队列研究，以 MTX 单药治疗 6 个月时添加 DMARDs 为结局，纳入了开始 MTX 单药治疗的 RA 患者。·较高的 SJC28（OR 1.390；95% CI，1.036-1.866）和关节内 GC 注射史（OR 3.678；95% CI，1.170-11.557）可能是 MTX 单药治疗 6 个月时添加 DMARDs 的有用预测指标。·使用这些指标可能有助于在初始 MTX 单药治疗后做出添加 DMARDs 的早期决策。
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