Apostolova Zhaklin, Shivacheva Tanya, Georgiev Tsvetoslav
First Department of Internal Medicine, Faculty of Medicine, Medical University-Varna, 9002 Varna, Bulgaria.
Rheumatology Department, St. Marina Hospital, 1, Hristo Smirnenski Blvd, 9010 Varna, Bulgaria.
Antibodies (Basel). 2025 Jun 30;14(3):54. doi: 10.3390/antib14030054.
The present study aimed to evaluate the long-term survival of patients with rheumatoid arthritis (RA) receiving biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in a real-world setting, and to identify key prognostic factors influencing mortality within this cohort.
This retrospective, observational cohort study analyzed 165 patients with confirmed RA who were on b/tsDMARD treatment for at least six months as of June 2017. Patient data, including demographics, disease duration, prior therapeutic regimens, and global functional status were extracted from medical records to collect data covering a seven-year follow-up period, extending from June 2017 to December 2024. Corticosteroid use was defined as continuous systemic intake during the RA activity analysis period. Survival outcomes were analyzed using Kaplan-Meier methods and multivariate Cox proportional hazards models to identify independent predictors of mortality.
Over a mean follow-up of 9.4 years, the mortality rate was 13.5 deaths per 1000 treatment-years, with an overall survival rate of 87.3%. Advanced functional disability and prolonged corticosteroid use were independently associated with higher mortality risk. In subgroup analyses, chronic kidney disease significantly increased mortality among patients on TNF inhibitors. In contrast, patients who remained on their initial anti-IL6 therapy had lower mortality, though this may reflect survivor bias.
This study highlights the importance of long-term b/tsDMARD intervention in RA patients, with observed low mortality and high survival rates. Subgroup findings suggest the importance of comorbidity management in TNFi users and therapeutic stability in anti-IL6 users.
本研究旨在评估在真实世界中接受生物制剂或靶向合成改善病情抗风湿药物（b/tsDMARDs）治疗的类风湿关节炎（RA）患者的长期生存率，并确定影响该队列患者死亡率的关键预后因素。
这项回顾性观察性队列研究分析了截至2017年6月接受b/tsDMARD治疗至少6个月的165例确诊RA患者。从病历中提取患者数据，包括人口统计学资料、病程、既往治疗方案和整体功能状态，以收集涵盖2017年6月至2024年12月七年随访期的数据。在RA活动分析期内，糖皮质激素的使用定义为持续全身摄入。使用Kaplan-Meier方法和多变量Cox比例风险模型分析生存结果，以确定死亡率的独立预测因素。
在平均9.4年的随访中，死亡率为每1000治疗年13.5例死亡，总生存率为87.3%。严重功能残疾和长期使用糖皮质激素与较高的死亡风险独立相关。在亚组分析中，慢性肾脏病显著增加了使用肿瘤坏死因子（TNF）抑制剂患者的死亡率。相比之下，持续使用初始抗白细胞介素6（IL6）治疗的患者死亡率较低，尽管这可能反映了幸存者偏倚。
本研究强调了b/tsDMARD对RA患者进行长期干预的重要性，观察到死亡率低且生存率高。亚组研究结果表明，合并症管理对使用TNF抑制剂的患者很重要，而治疗稳定性对抗IL6治疗的患者很重要。
