Department of Biochemistry, Jichi Medical University School of Medicine, Tochigi, Japan.
Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 3290498, Japan.
Sci Rep. 2022 Oct 3;12(1):16547. doi: 10.1038/s41598-022-21160-0.
Since the advent of biological disease modifying anti-rheumatic drugs (bDMARDs) in the treatment of rheumatoid arthritis (RA), most RA patients receiving such drugs have achieved remission at the expense of cost and infection risk. After bDMARDs are withdrawn, a substantial proportion of patients would have relapses even if they were in complete remission. In our previous report, relapse prediction could be made at the time of bDMARD withdrawal by measuring the serum levels of five cytokines. We report herein that, among 73 cytokines examined, serum levels of only interferon β (IFNβ) at the time of bDMARD withdrawal could predict early relapse (within 5 months) in patients who were categorized to relapse by the five cytokines in our previous report, with a cut-off value of 3.38 in log and AUC of 0.833. High serum levels of IFNβ in the early-relapse group remained high until actual relapse occurred. Therefore, patients who relapse early might be biochemically different from those who relapse late or do not relapse at all. We recommend that patients who are predicted to relapse early continue bDMARDs even if they are in complete remission. This finding contributes to shared decision-making regarding how and when bDMARDs should be discontinued.
自从生物疾病修饰抗风湿药物（bDMARDs）在类风湿关节炎（RA）的治疗中出现以来，大多数接受此类药物治疗的 RA 患者都以成本和感染风险为代价实现了缓解。在停用 bDMARDs 后，即使患者处于完全缓解状态，仍有相当一部分患者会复发。在我们之前的报告中，通过测量五种细胞因子的血清水平，可以在 bDMARD 停药时进行复发预测。我们在此报告，在检查的 73 种细胞因子中，只有干扰素β（IFNβ）在 bDMARD 停药时的血清水平可以预测我们之前报告中通过五种细胞因子分类为复发的患者的早期复发（5 个月内），截断值为 3.38 在对数和 AUC 为 0.833。在早期复发组中，高血清 IFNβ水平一直保持高位，直到实际复发发生。因此，早期复发的患者可能在生化上与晚期复发或根本不复发的患者有所不同。我们建议即使患者处于完全缓解状态，预测早期复发的患者也应继续使用 bDMARDs。这一发现有助于就如何以及何时停止使用 bDMARDs 做出共同决策。
