Effect of sustained intensive therapy with disease modifying anti-rheumatic drugs in rheumatoid arthritis:a 5-year real-world consecutive study  

作　　者：Yue-Ming Cai Ru Li Hua Ye Jing He Xiao-Lin Sun Jia-Yang Jin Jia-Jia Liu Yu-Zhou Gan Xu-Jie You Jing Xu Lian-Jie Shi Gong Cheng Qing-Wen Wang Zhan-Guo Li 

机构地区：[1]Department of Rheumatology and Immunology,Peking University People’s Hospital,Beijing 100044,China [2]Department of Rheumatology and Immunology,Peking University Shenzhen Hospital,Shenzhen,Guangdong 518035,China [3]Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis(BZ0135),Beijing 100044,China [4]Peking-Tsinghua Center for Life Sciences,Peking University,Beijing 100044,China [5]Department of Rheumatology and Immunology,Peking University International Hospital,Beijing 102206,China

出　　处：《Chinese Medical Journal》2020年第12期1397-1403,共7页中华医学杂志（英文版）

基　　金：This study was supported by the grants from the National Natural Science Foundation of China(Nos.81701598 and 31240023);Beijing Municipal Science and Technology Projects(Nos.Z171100000417007 and Z191100006619110).

摘　　要：Background:Intensive therapy with disease modifying anti-rheumatic drugs(DMARDs)has been reported to improve the outcomes of rheumatoid arthritis(RA).However,real-world study on the effect of intensive therapy on RA sustained remission is still lacking.This study aimed to investigate the outcome of sustained intensive DMARD therapy(SUIT)for RA in a real-world 5-year consecutive cohort.Methods:Based on a consecutive cohort of 610 out-patients with RA,remission of RA was assessed in 541 patients from 2012 to 2017,by dividing into SUIT,non-SUIT,and intermittent SUIT(Int-SUIT)groups.Changes in the disease activity scores were evaluated by 28-joint disease activity score based on erythrocyte sedimentation rate(DAS28-ESR),28-joint disease activity score based on C-reactive protein(DAS28-CRP),and clinical deep remission criteria(CliDR).Cumulative remission rates between different groups were compared using Kaplan-Meier curves and predictive factors of sustained remission were identified by univariate and multivariate logistic regression analysis.Results:The remission rates of the SUIT group decreased from 12.0%(65/541)to 5.6%(20/359)based on DAS28-ESR,from 14.0%(76/541)to 7.2%(26/359)based on DAS28-CRP,and from 8.5%(46/541)to 3.1%(11/359)based on CliDR,respectively,with a gradually decreasing trend during the 5 years.The SUIT regimen led to a significantly higher cumulative remission rate than non-SUIT regimen based on DAS28-ESR(39.7%vs.19.5%,P=0.001),DAS28-CRP(42.0%vs.19.6%,P=0.001),and CliDR(24.5%vs.8.7%,P=0.001).The cumulative remission rates of patients treated with SUIT regimen were significantly higher than those treated with Int-SUIT regimen based on DAS28-ESR(39.7%vs.25.7%,P=0.043)and CliDR(24.5%vs.14.2%,P=0.047),but there was no significant difference between the two groups based on DAS28-CRP(42.0%vs.27.4%,P=0.066).Multivariate logistic regression analysis showed that the use of SUIT regimen was an independent favorable predictor according to different remission definitions(for DAS28-ESR:odds ratio[OR],2.215,95

关 键 词：Rheumatoid arthritis REMISSION Sustained intensive therapy Cohort study 

分 类 号：R593.22[医药卫生—内科学]