Servicio de Reumatología, Hospital Universitario Ramón Y CajalInstituto Ramón Y Cajal de Investigación Sanitaria (IRYCIS), Carretera de Colmenar Viejo Km: 9,100, 28034, Madrid, Spain.
Health Technology Assessment Agency of Carlos III Institute of Health (ISCIII), Madrid, Spain.
Arthritis Res Ther. 2023 May 22;25(1):86. doi: 10.1186/s13075-023-03045-3.
The objectives of this study were to assess the discontinuation of biologic therapy in patients who achieve remission and identify predictors of discontinuation of biologics in patients with inflammatory arthritis in remission.
An observational retrospective study from the BIOBADASER registry comprising adult patients diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) and receiving 1 or 2 biological disease-modifying drugs (bDMARDs) between October 1999 and April 2021. Patients were followed yearly after initiation of therapy or until discontinuation of treatment. Reasons for discontinuation were collected. Patients who discontinued bDMARDs because of remission as defined by the attending clinician were studied. Predictors of discontinuation were explored using multivariable regression models.
The study population comprised 3,366 patients taking 1 or 2 bDMARDs. Biologics were discontinued owing to remission by 80 patients (2.4%): 30 with RA (1.7%), 18 with AS (2.4%), and 32 with PsA (3.9%). The factors associated with a higher probability of discontinuation on remission were shorter disease duration (OR: 0.95; 95% CI: 0.91-0.99), no concomitant use of classic DMARDs (OR: 0.56; 95% CI: 0.34-0.92), and shorter usage of the previous bDMARD (before the decision to discontinue biological therapy) (OR: 1.01; 95% CI: 1.01-1.02); in contrast, smoking status (OR: 2.48; 95% CI: 1.21-5.08) was associated with a lower probability. In patients with RA, positive ACPA was associated with a lower probability of discontinuation (OR: 0.11; 95% CI: 0.02-0.53).
Discontinuation of bDMARDs in patients who achieve remission is uncommon in routine clinical care. Smoking and positive ACPA in RA patients were associated with a lower probability of treatment discontinuation because of clinical remission.
本研究旨在评估达到缓解的患者停止生物制剂治疗的情况，并确定处于缓解期的炎症性关节炎患者停止生物制剂治疗的预测因素。
这是一项来自 BIOBADASER 登记处的观察性回顾性研究，纳入了 1999 年 10 月至 2021 年 4 月期间接受 1 种或 2 种生物疾病修正药物（bDMARDs）治疗的成人类风湿关节炎（RA）、强直性脊柱炎（AS）或银屑病关节炎（PsA）患者。在开始治疗后每年进行随访，直至停止治疗。收集停药原因。研究了因临床医生定义的缓解而停止 bDMARDs 治疗的患者。使用多变量回归模型探索停药的预测因素。
该研究人群包括 3366 名接受 1 种或 2 种 bDMARDs 治疗的患者。80 名患者（2.4%）因缓解而停止使用生物制剂：30 名 RA 患者（1.7%）、18 名 AS 患者（2.4%）和 32 名 PsA 患者（3.9%）。与较高缓解停药概率相关的因素包括：较短的疾病病程（OR：0.95；95%CI：0.91-0.99）、不合并使用传统 DMARDs（OR：0.56；95%CI：0.34-0.92）和较短的前一种 bDMARD 用药时间（在决定停止生物治疗之前）（OR：1.01；95%CI：1.01-1.02）；相比之下，吸烟状态（OR：2.48；95%CI：1.21-5.08）与较低的停药概率相关。在 RA 患者中，抗 CCP 抗体阳性与较低的停药概率相关（OR：0.11；95%CI：0.02-0.53）。
在常规临床护理中，达到缓解的患者停止 bDMARDs 治疗并不常见。吸烟和 RA 患者的抗 CCP 抗体阳性与因临床缓解而停止治疗的概率降低相关。
