Division of Rheumatology, Allegheny Health Network, Pittsburgh, PA, USA.
Bioinformatics, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA.
Rheumatology (Oxford). 2023 Oct 19;62(Suppl_4):iv8-iv13. doi: 10.1093/rheumatology/kead430.
This study had two aims: (i) to investigate outcomes of medication tapering in stable RA patients on biologic or targeted synthetic disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) and conventional synthetic DMARDs (csDMARDs) in a real-world prospective cohort; and (ii) to evaluate possible predictors of flare with medication taper.
A prospective cohort of patients with RA in sustained remission or low disease activity while on stable bDMARD/tsDMARDs +/- csDMARDs for at least 6 months underwent medication tapering/stopping and was tracked for 2 years. Patients were evaluated for flares in four groups: no taper, only bDMARD/tsDMARD taper, only csDMARD taper and both csDMARD and bDMARD/tsDMARD taper.
The RHEUMTAP cohort included 131 patients that met eligibility criteria, of which 52 patients underwent a medication taper. Flare was experienced by 15 patients in the taper and two in the no-taper groups. Patients undergoing any taper/stop overall were 10 times more likely to experience a flare compared with those not tapered (HR 10.43, 95% CI 2.98-36.53, P = 0.0002). The group tapering bDMARD/tsDMARD had 31 times higher risk of flare (HR 31.43, 95% CI 6.35-155.55, P <0.0001) than the no-taper group. Patients tapering both csDMARDs and bDMARD/tsDMARDs had 18 times higher risk of flare than the no-taper group (HR 18.45, 95% CI 2.55-133.37, P = 0.0039). The only csDMARD taper group had a 91% lower risk of flare than the bDMARD/tsDMARD taper group (HR 0.09, 95% CI 0.01-0.69, P = 0.0213).
In our real-world prospective RHEUMTAP cohort study on the outcomes of different medication tapering groups in well-controlled RA, patients who tapered or stopped bDMARDs/tsDMARDs with or without background therapy were more likely to experience a flare than patients that did not taper any medications and those that tapered only csDMARDs.
本研究旨在：(i) 调查稳定期 RA 患者在生物制剂或靶向合成疾病修饰抗风湿药物（bDMARD/tsDMARD）和常规合成 DMARD（csDMARD）治疗下逐渐减少药物剂量的结果；(ii) 评估药物逐渐减少与病情复发的可能预测因素。
前瞻性队列研究纳入了至少 6 个月接受 bDMARD/tsDMARD 联合/不联合 csDMARD 稳定治疗且处于缓解或低疾病活动度的 RA 患者，患者逐渐减少或停止药物治疗，并随访 2 年。评估 4 组患者的复发情况：无药物减量、仅 bDMARD/tsDMARD 减量、仅 csDMARD 减量和 csDMARD 和 bDMARD/tsDMARD 同时减量。
RHEUMTAP 队列纳入了 131 名符合入组标准的患者，其中 52 名患者进行了药物减量。在减量组中，有 15 名患者和 2 名未减量组患者出现了病情复发。与未减量的患者相比，所有减量/停药的患者出现病情复发的风险高 10 倍（HR 10.43，95%CI 2.98-36.53，P=0.0002）。减量 bDMARD/tsDMARD 的患者病情复发风险高 31 倍（HR 31.43，95%CI 6.35-155.55，P<0.0001），而未减量的患者风险高 18 倍（HR 18.45，95%CI 2.55-133.37，P=0.0039）。同时减量 csDMARD 和 bDMARD/tsDMARD 的患者病情复发风险高 18 倍（HR 18.45，95%CI 2.55-133.37，P=0.0039），而未减量的患者风险高 18 倍（HR 18.45，95%CI 2.55-133.37，P=0.0039）。仅 csDMARD 减量组的复发风险比 bDMARD/tsDMARD 减量组低 91%（HR 0.09，95%CI 0.01-0.69，P=0.0213）。
在我们的真实世界前瞻性 RHEUMTAP 队列研究中，对控制良好的 RA 患者进行不同药物减量组的结果进行了评估，与未减量的患者相比，减量或停止 bDMARD/tsDMARD 联合或不联合背景治疗的患者更有可能出现病情复发，而仅减量 csDMARD 的患者则不太可能出现病情复发。
