Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.
Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis.
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DOI：
10.1136/annrheumdis-2018-213378
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发表时间：
2018-10
影响因子：
27.4
通讯作者：
BSRBR-RA Contributors Group
中科院分区：
文献类型：
--
作者：
Kearsley-Fleet L;Davies R;De Cock D;Watson KD;Lunt M;Buch MH;Isaacs JD;Hyrich KL;BSRBR-RA Contributors Group
生物疾病缓解抗风湿药物（bDMARDs）彻底改变了类风湿关节炎（RA）的治疗和结局。如果当前治疗无效，扩展的库允许切换bDMARD的选择。对于一些患者，即使在转换后，疾病控制仍然难以实现。该分析旨在量化bDMARD难治性疾病的频率并确定与bDMARD难治性疾病相关的因素。纳入了2001年至2014年英国风湿病学会生物制品注册中开始一线肿瘤坏死因子抑制剂治疗的RA患者。我们将患者定义为bDMARD难治性，在他们开始第三类bDMARD的日期。在末次随访日期（2016年11月30日）或死亡（以先发生者为准）时删失随访。研究了bDMARDs的开关模式和停止原因。考克斯回归确定了与难治性疾病相关的基线临床因素。使用缺失基线数据的多重插补。13502例患者中有867例（6%）为bDMARD难治性;至第三个bDMARD分类的中位时间为8年。在多变量分析中，与bDMARD难治性疾病相关的基线因素包括最近登记的患者、女性、年龄较小、病程较短、患者总体评估较高、健康评估问卷评分较高、目前吸烟者、肥胖和社会剥夺程度较高。这是第一项全国性研究，已确定bDMARD难治性疾病的频率至少为6%的患者曾经接受过bDMARD。随着bDMARD选择的增加，患者更快地循环使用bDMARD。bDMARD难治性疾病的病因需要进一步研究。集中资源，如护理支持，对这些患者可以帮助他们实现更稳定，控制疾病。
Biologic disease-modifying antirheumatic drugs (bDMARDs) have revolutionised treatment and outcomes for rheumatoid arthritis (RA). The expanding repertoire allows the option of switching bDMARD if current treatment is not effective. For some patients, even after switching, disease control remains elusive. This analysis aims to quantify the frequency of, and identify factors associated with, bDMARD refractory disease. Patients with RA starting first-line tumour necrosis factor inhibitor in the British Society for Rheumatology Biologics Register for RA from 2001 to 2014 were included. We defined patients as bDMARD refractory on the date they started their third class of bDMARD. Follow-up was censored at last follow-up date, 30 November 2016, or death, whichever came first. Switching patterns and stop reasons of bDMARDs were investigated. Cox regression identified baseline clinical factors associated with refractory disease. Multiple imputation of missing baseline data was used. 867 of 13 502 (6%) patients were bDMARD refractory; median time to third bDMARD class of 8 years. In the multivariable analysis, baseline factors associated with bDMARD refractory disease included patients registered more recently, women, younger age, shorter disease duration, higher patient global assessment, higher Health Assessment Questionnaire score, current smokers, obesity and greater social deprivation. This first national study has identified the frequency of bDMARD refractory disease to be at least 6% of patients who have ever received bDMARDs. As the choice of bDMARDs increases, patients are cycling through bDMARDs quicker. The aetiopathogenesis of bDMARD refractory disease requires further investigation. Focusing resources, such as nursing support, on these patients may help them achieve more stable, controlled disease.
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影响因子：
27.4
作者：
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通讯作者：
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影响因子：
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影响因子：
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