糖皮质激素递减和停药在联合 csDMARDs 起始糖皮质激素治疗的类风湿关节炎患者中的动态轨迹：来自 2009 年至 2020 年的真实世界数据。
Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020.
机构信息
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
出版信息
Ann Rheum Dis. 2021 Aug;80(8):997-1003. doi: 10.1136/annrheumdis-2021-220112. Epub 2021 Apr 2.
OBJECTIVE
To unravel the dynamical trajectory and features of glucocorticoids (GC) tapering and discontinuation in patients with rheumatoid arthritis (RA) commencing GC with concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
METHODS
We used data from longitudinal real-world Treat-to-TARget in RA cohort. Patients with RA who started GC and contaminant csDMARDs therapy were included. The changes in GC dose and disease activity were evaluated. GC discontinuation rate was analysed using Kaplan-Meier analysis. The relapse profile within 6 months after GC discontinuation was also analysed.
RESULTS
A total of 207 patients with RA were included. During a median follow-up of 38.6 months, 124 patients discontinued GC. The median prednisolone dose of 10 (5-10) mg/day at initiation was reduced by 50% in the first 6 months and then more slowly, to zero by 48 months eventually. The cumulative probabilities of GC discontinuation were 9.7%, 26.6%, 48.0% and 58.6% at month 6, years 1, 2 and 3, with calculated median time to GC cessation of 27 months. In 110 DMARD-naïve patients, the corresponding cumulative probabilities of GC discontinuation were, respectively, 12.7%, 30.0%, 50.9% and 60.6%, with calculated median time to GC cessation of 24 months. Of the 124 patients who discontinued GC, adding other csDMARDs or concomitant csDMARDs increment was documented in 28.2% of them. Approximately half of 124 patients were in clinical remission at GC discontinuation. Within 6 months after GC withdrawal, 79.1% (91/115) of patients maintained relapse free.
CONCLUSIONS
In patients with RA commencing GC besides csDMARDs, GC is feasibly discontinued with favourable control of disease activity in real-life setting, mostly without short-term flare. But the withdrawal time is far from reaching the recommended time frame, indicating the gap between real-world practice and current guidelines.
目的
揭示开始接受糖皮质激素（GC）联合常规合成疾病修饰抗风湿药物（csDMARDs）治疗的类风湿关节炎（RA）患者中 GC 逐渐减量和停药的动态轨迹和特征。
方法
我们使用了纵向真实世界治疗至 RA 目标（Treat-to-TARget in RA）队列的研究数据。纳入了开始接受 GC 和混杂 csDMARDs 治疗的 RA 患者。评估 GC 剂量和疾病活动度的变化。使用 Kaplan-Meier 分析评估 GC 停药率。还分析了 GC 停药后 6 个月内的复发情况。
结果
共纳入 207 例 RA 患者。中位随访 38.6 个月期间，124 例患者停用 GC。起始时 10（5-10）mg/天的泼尼松龙剂量在最初 6 个月内减少 50%，然后逐渐减少，最终在 48 个月时降至零。GC 停药的累积概率分别为 6 个月时的 9.7%、1 年时的 26.6%、2 年时的 48.0%和 3 年时的 58.6%，计算出 GC 停药的中位时间为 27 个月。在 110 例 DMARD 初治患者中，GC 停药的累积概率分别为 12.7%、30.0%、50.9%和 60.6%，计算出 GC 停药的中位时间为 24 个月。在 124 例停用 GC 的患者中，有 28.2%的患者记录了加用其他 csDMARDs 或同时增加 csDMARDs。大约一半的 124 例患者在 GC 停药时处于临床缓解状态。在 GC 停药后 6 个月内，79.1%（91/115）的患者无复发。
结论
在开始接受 GC 联合 csDMARDs 治疗的 RA 患者中，GC 可以在现实环境中实现疾病活动的良好控制下逐渐停药，且大多没有短期复发。但停药时间远未达到推荐的时间框架，这表明现实世界的实践与当前指南之间存在差距。
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