Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), UMR S 1136, Sorbonne Université, Paris, France
APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France.
RMD Open. 2022 May;8(1). doi: 10.1136/rmdopen-2021-002040.
This study aimed to assess the impact of disease-modifying antirheumatic drugs (DMARDs) on 10-year outcomes in rheumatoid arthritis (RA).
Patients with RA from the ESPOIR cohort with complete data on Disease Activity Score in 28 Joints (DAS28) and Health Assessment Questionnaire (HAQ) at 10 years (n=418) and complete radiographic data at baseline and 10 years (n=343) were included in this study. Outcomes were favourable outcome (FavOut) at 10 years, defined as DAS28 of <2.6 and HAQ score of <0.5 at 10 years, and absence of structural damage progression (AbsSDP) at 10 years, defined as change in Sharp-van der Heijde Score less than the smallest detectable change at 10 years (11.5 points). Three multivariate logistic regression models predicting 10-year outcome were built, considering (1) baseline variables only, (2) baseline variables and DMARD exposure (ever exposed, yes/no) and (3) baseline variables and DMARD exposure as weighted cumulative exposure (WCE) variables.
Overall, 196/418 (46.9%) patients showed FavOut and 252/343 (73.5%) AbsSDP. WCE models had the best predictive performance, with area under the curve=0.80 (95% CI 0.74 to 0.87) for FavOut and 0.87 (95% CI 0.83 to 0.92) for AbsSDP. In the WCE model, the odds of FavOut and AbsSDP were reduced with conventional synthetic disease-modifying antirheumatic drug (csDMARD) initiation at 12 months versus at baseline (OR 0.78, 95% CI 0.65 to 0.94, and OR 0.89, 95% CI 0.76 to 0.98, respectively). Early biologics initiation was not significantly associated with either outcome.
WCE models can identify and quantify the long-term benefit of early csDMARD initiation on 10-year functional and structural outcomes in patients with RA.
本研究旨在评估疾病修饰抗风湿药物（DMARDs）对类风湿关节炎（RA）患者 10 年结局的影响。
纳入 ESPOIR 队列中符合以下条件的 RA 患者：10 年时 DAS28 和健康评估问卷（HAQ）数据完整（n=418），且基线和 10 年时完整的放射学数据（n=343）。主要结局为 10 年时的良好结局（FavOut），定义为 10 年时 DAS28<2.6 和 HAQ 评分<0.5；次要结局为 10 年时无结构损伤进展（AbsSDP），定义为 10 年时 Sharp-van der Heijde 评分的变化小于最易检测变化（11.5 分）。建立了三个多变量逻辑回归模型来预测 10 年结局，考虑了（1）仅基线变量，（2）基线变量和 DMARD 暴露（既往暴露，是/否），（3）基线变量和 DMARD 暴露作为加权累积暴露（WCE）变量。
共有 418 例患者中的 196 例（46.9%）达到 FavOut，343 例患者中的 252 例（73.5%）达到 AbsSDP。WCE 模型具有最佳的预测性能，FavOut 的曲线下面积为 0.80（95%CI 0.74 至 0.87），AbsSDP 的曲线下面积为 0.87（95%CI 0.83 至 0.92）。在 WCE 模型中，与基线相比，12 个月时开始使用传统合成 DMARD（csDMARD）治疗 FavOut 和 AbsSDP 的可能性降低（OR 0.78，95%CI 0.65 至 0.94 和 OR 0.89，95%CI 0.76 至 0.98）。早期生物制剂的起始与两种结局均无显著相关性。
WCE 模型可以识别和量化早期 csDMARD 起始治疗对 RA 患者 10 年功能和结构结局的长期获益。
