类风湿关节炎患者停用任何生物改善病情抗风湿药物的原因和风险因素：一项长期观察性研究。

Reasons and risk factors for discontinuation of treatment with any biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A long-term observational study.

机构信息

Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan.

出版信息

Mod Rheumatol. 2023 Aug 25;33(5):891-898. doi: 10.1093/mr/roac090.

DOI:10.1093/mr/roac090

PMID:35975317

Abstract

OBJECTIVES

Patients with rheumatoid arthritis (RA) usually switch to a second biological disease-modifying antirheumatic drugs (bDMARDs) when the first has proven to be ineffective, although some may discontinue bDMARDs treatment altogether. We investigated the total rate of bDMARDs retention and the risk of bDMARDs discontinuation in patients with RA.

METHODS

The study included 564 patients with RA who started bDMARDs treatment before 2008 (<65 years old, n = 413; ≥65, n = 151). The primary outcome was the incidence of bDMARDs discontinuation due to adverse events (AEs). Risk factors were examined using Fine and Gray regression models.

RESULTS

Among 564 patients, 74 had discontinued bDMARDs treatment due to AEs. Male sex and Steinbrocker class 3-4 were more frequent, while rheumatoid factor and concomitant methotrexate treatment were less frequent, in those aged ≥65 years than in those aged <65 years, respectively. The subdistribution hazard ratio for discontinuation was significantly higher in the ≥65 group than in the <65 years group (hazard ratio = 3.53, 95% confidence interval = 2.07-6.03). Lack of concomitant treatment with MTX was risk factor for discontinuation in patients ≥65 years. Advanced Steinbrocker class was a risk factor in patients <65 years.

CONCLUSIONS

Older patients are at higher risk of discontinuing bDMARDs treatment due to AEs than younger patients.

摘要

目的

类风湿关节炎（RA）患者在最初使用的生物改善病情抗风湿药物（bDMARDs）疗效不佳时，通常会转而使用第二种药物，但也有部分患者会完全停止 bDMARDs 治疗。本研究旨在调查 RA 患者 bDMARDs 保留的总体比率和 bDMARDs 停药的风险。

方法

本研究纳入了 564 例于 2008 年前开始接受 bDMARDs 治疗的 RA 患者（<65 岁，n=413；≥65 岁，n=151）。主要结局为因不良事件（AE）而导致的 bDMARDs 停药发生率。采用 Fine 和 Gray 回归模型来检验风险因素。

结果

在 564 例患者中，有 74 例因 AE 而停止 bDMARDs 治疗。与<65 岁患者相比，≥65 岁患者中男性比例和 Steinbrocker 3-4 级更高，而类风湿因子和甲氨蝶呤（MTX）联合治疗比例更低。≥65 岁组的亚分布危险比（HR）显著高于<65 岁组（HR=3.53，95%置信区间：2.07-6.03）。≥65 岁患者中，缺乏 MTX 联合治疗是停药的风险因素。而在<65 岁患者中，较高的 Steinbrocker 分级是停药的风险因素。