Sapart Emilie, Sokolova Tatiana, de Montjoye Stéphanie, Dierckx Stéphanie, Nzeusseu Adrien, Avramovska Aleksandra, Meric de Bellefon Laurent, Durez Patrick
Department of Rheumatology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), 10, Avenue Hippocrate, 1200, Brussels, Belgium.
Rheumatology, CHU Mont-Godinne, Mont-Godinne, Belgium.
Rheumatol Ther. 2023 Aug;10(4):875-886. doi: 10.1007/s40744-023-00551-3. Epub 2023 May 14.
This study sought to analyze the benefit of an early induction therapy with a biological disease-modifying anti-rheumatic drugs (bDMARD) during the first year of treatment with a 5-year follow-up in early rheumatoid arthritis (ERA).
We included ERA patients from the UCLouvain Brussels cohort who met the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 classification criteria and were naïve to DMARDs. ERA patients were divided into two groups according to whether they received an induction bDMARD therapy or a standard therapy with methotrexate (MTX). Clinical response after the induction treatment at 6 and 12 months followed by a MTX maintenance therapy at 36 and 60 months was evaluated.
Data from 470 ERA patients were collected, 189 received a bDMARD and 281 initiated MTX alone. In the bDMARD group, disease activity and HAQ were higher at baseline. A total of 391 patients were followed up to 5 years. We then divided each group into two subgroups according to the last treatment they received at 5 years: bDMARD > MTX (n = 95), bDMARD > bDMARD (n = 59); MTX > MTX (n = 134), MTX > bDMARD (n = 103). During the induction, we observed a clinical response with a large number of patients achieving DAS28-CRP remission. According to a treat-to-target (T2T) approach, remission rate was stable on MTX monotherapy or rescued by the addition or prolongation of a bDMARD. Interestingly, bDMARD followed by a MTX maintenance therapy experienced a stable and sustained DAS28-CRP remission rate in 53% of the ERA patients at year 5.
Long-term remission is an achievable goal in ERA. Our results suggest that a bDMARD induction therapy followed by MTX maintenance therapy could be an interesting option.
本研究旨在分析在早期类风湿关节炎（ERA）治疗的第一年使用生物性改善病情抗风湿药物（bDMARD）进行早期诱导治疗，并进行5年随访的益处。
我们纳入了来自鲁汶大学布鲁塞尔队列的ERA患者，这些患者符合美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）2010分类标准且未使用过改善病情抗风湿药物（DMARD）。ERA患者根据是否接受诱导性bDMARD治疗或甲氨蝶呤（MTX）标准治疗分为两组。评估了诱导治疗6个月和12个月后的临床反应，随后是36个月和60个月的MTX维持治疗。
收集了470例ERA患者的数据，189例接受了bDMARD治疗，281例仅开始使用MTX。在bDMARD组中，基线时疾病活动度和健康评估问卷（HAQ）较高。共有391例患者随访了5年。然后我们根据他们在5年时接受的最后一种治疗将每组分为两个亚组：bDMARD＞MTX（n = 95），bDMARD＞bDMARD（n = 59）；MTX＞MTX（n = 134），MTX＞bDMARD（n = 103）。在诱导治疗期间，我们观察到大量患者实现疾病活动评分28（DAS28）-C反应蛋白（CRP）缓解的临床反应。根据达标治疗（T2T）方法，MTX单药治疗的缓解率稳定，或通过添加或延长bDMARD得以挽救。有趣的是，在第5年，53%的ERA患者在接受bDMARD治疗后再进行MTX维持治疗，其DAS28-CRP缓解率稳定且持续。
长期缓解是ERA可实现的目标。我们的结果表明，bDMARD诱导治疗后进行MTX维持治疗可能是一个不错的选择。
