一项针对类风湿关节炎药物减量（RHEUMTAP）队列中病情控制良好的类风湿关节炎患者进行药物减量的真实世界、2 年前瞻性研究。
A real-world 2-year prospective study of medication tapering in patients with well-controlled rheumatoid arthritis within the rheumatoid arthritis medication tapering (RHEUMTAP) cohort.
机构信息
Division of Rheumatology, Allegheny Health Network, Pittsburgh, PA, USA.
Bioinformatics, Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA.
出版信息
Rheumatology (Oxford). 2023 Oct 19;62(Suppl_4):iv8-iv13. doi: 10.1093/rheumatology/kead430.
OBJECTIVES
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
目的
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。
方法
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。
结果
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）。
结论
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。
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