早期坚持治疗可影响无药物缓解：一项在近期发病的西班牙裔类风湿关节炎患者队列中进行的病例对照研究。
Early persistence on therapy impacts drug-free remission: a case-control study in a cohort of Hispanic patients with recent-onset rheumatoid arthritis.
机构信息
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
Emergency Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
出版信息
Arthritis Res Ther. 2022 Aug 12;24(1):193. doi: 10.1186/s13075-022-02884-w.
BACKGROUND
Medication adherence is suboptimal in rheumatoid arthritis (RA) patients and impacts outcomes. DMARD-free remission (DFR) is a sustainable and achievable outcome in a minority of RA patients. Different factors have been associated with DFR, although persistence in therapy (PT), a component of the adherence construct, has never been examined. The study's primary aim was to investigate the impact of PT's characteristics on DFR in a cohort of Hispanic patients with recent-onset RA.
METHODS
A single data abstractor reviewed the charts from 209 early (symptoms duration ≤ 1 year) RA patients. All the patients had prospective assessments of disease activity and PT and at least 1 year of follow-up, which was required for the DFR definition. DFR was defined when patients achieved ≥ 1 year of continuous Disease Activity Score-28 joints evaluated ≤ 2.6, without DMARDs and corticosteroids. PT was defined based on pre-specified criteria and recorded through an interview from 2004 to 2008 and thereafter through a questionnaire. Cases (patients who achieved ≥ 1 DFR status) were paired with controls (patients who never achieved DFR during their entire follow-up) according to ten relevant variables (1:2). Cox regression analysis estimated hazard ratios (HRs) for DFR according to two characteristics of PT: the % of the patient follow-up PT and early PT (first 2 years of patients' follow-up).
RESULTS
In March 2022, the population had 112 (55-181) patient/years follow-up. There were 23 patients (11%) with DFR after 74 months (44-122) of follow-up, and the DFR status was maintained during 48 months (18-82). Early PT was associated with DFR, while the % of the patient follow-up PT was not: HR = 3.84 [1.13-13.07] when the model was adjusted for cumulative N of DMARDs/patient and 3.16 [1.14-8.77] when also adjusted for baseline SF-36 physical component score. A lower N of cumulative DMARDs/patient was also retained in the models. Receiving operating curve to define the best cutoff of patient follow-up being PT to predict DFR was 21 months: sensitivity of 0.739, specificity of 0.717, and area under the curve of 0.682 (0.544-0.821).
CONCLUSIONS
DFR status might be added to the benefits of adhering to prescribed treatment.
背景
类风湿关节炎（RA）患者的药物依从性不理想，这会影响治疗效果。在少数 RA 患者中，无药物缓解（DFR）是一种可持续和可实现的治疗效果。虽然治疗持久性（PT）是依从性的一个组成部分，但它从未被研究过，但已有多种因素与 DFR 相关。本研究的主要目的是调查在一组近期发病的西班牙裔 RA 患者中，PT 特征对 DFR 的影响。
方法
一名数据录入员对 209 例早期（症状持续时间≤1 年）RA 患者的病历进行了回顾。所有患者均进行了疾病活动度和 PT 的前瞻性评估，且至少随访 1 年，这是 DFR 定义的要求。当患者达到≥1 年的连续 28 个关节疾病活动评分（DAS28）≤2.6，且未使用 DMARDs 和皮质激素时，定义为 DFR。PT 是根据预定义的标准定义的，并通过 2004 年至 2008 年的访谈以及之后的问卷调查进行记录。根据 10 个相关变量（1:2），将病例（达到≥1 次 DFR 状态的患者）与对照组（整个随访期间从未达到 DFR 的患者）进行配对。Cox 回归分析根据 PT 的两个特征：患者随访期间的 PT%和早期 PT（患者随访的前 2 年），估计 DFR 的风险比（HR）。
结果
截至 2022 年 3 月，该人群的患者随访时间为 112（55-181）患者/年。在 74 个月（44-122）的随访后，有 23 名（11%）患者达到 DFR，且在 48 个月（18-82）的随访中维持了 DFR 状态。早期 PT 与 DFR 相关，而患者随访期间的 PT%则没有相关性：当模型调整为每位患者累积 DMARDs 数量时，HR=3.84[1.13-13.07]，当模型还调整基线 SF-36 生理成分评分时，HR=3.16[1.14-8.77]。模型中还保留了每位患者累积 DMARDs 数量的低值。接受操作曲线来定义预测 DFR 的最佳患者随访 PT 时间为 21 个月：敏感性为 0.739，特异性为 0.717，曲线下面积为 0.682（0.544-0.821）。
结论
DFR 状态可能会增加遵守规定治疗方案的获益。
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