Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab.
Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab.
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DOI：
10.1136/annrheumdis-2013-204021
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发表时间：
2015-02
影响因子：
27.4
通讯作者：
Strangfeld A
中科院分区：
文献类型：
--
作者：
Listing J;Kekow J;Manger B;Burmester GR;Pattloch D;Zink A;Strangfeld A
调查疾病活动性、病程、治疗随时间的推移、合并症和传统危险因素对生存的影响。使用德国生物制品登记册 RABBIT 的数据。应用 Cox 回归研究在调整年龄、性别、合并症和吸烟后，时变协变量（通过 DAS28 测量的疾病活动度、功能能力、糖皮质激素治疗、生物或合成疾病缓解抗风湿药物 (DMARD)）对死亡率的影响。在 31 378 患者年的随访期间，8908 名患者中有 463 名死亡（标准化死亡率：1.49（95% CI 1.36 至 1.63））。与疾病持续低活动度的患者（平均 DAS28< 3.2）相比，患有持续性高度活动性疾病的患者（平均 DAS28 > 5.1）的死亡风险显着较高（调整后 HR (HRadj)=2.43；（95% CI 1.64 至 3.61））。功能不良和糖皮质激素> 5 mg/天的治疗与死亡率增加显着相关，与疾病活动无关。与接受肿瘤坏死因子 α (TNFα) 抑制剂 (HRadj=0.64 (95% CI 0.50 - 0.81)、利妥昔单抗 (HRadj=0.57 (95% CI 0.39 - 0.84)) 或其他生物制剂 (HRadj=0.64 (95% CI 0.42 - 0.99)) 治疗的患者相比，死亡率显着降低。考虑到接受甲氨蝶呤治疗的患者存在风险，计算出曾经接触过 TNFα 抑制剂或利妥昔单抗的患者的 HRadj 为 0.77（95% CI 0.60 至 0.97）。来降低这种风险。
To investigate the impact of disease activity, the course of the disease, its treatment over time, comorbidities and traditional risk factors on survival. Data of the German biologics register RABBIT were used. Cox regression was applied to investigate the impact of time-varying covariates (disease activity as measured by the DAS28, functional capacity, treatment with glucocorticoids, biologic or synthetic disease modifying antirheumatic drugs (DMARDs)) on mortality after adjustment for age, sex, comorbid conditions and smoking. During 31 378 patient-years of follow-up, 463 of 8908 patients died (standardised mortality ratio: 1.49 (95% CI 1.36 to 1.63)). Patients with persistent, highly active disease (mean DAS28 > 5.1) had a significantly higher mortality risk (adjusted HR (HRadj)=2.43; (95% CI 1.64 to 3.61)) than patients with persistently low disease activity (mean DAS28 < 3.2). Poor function and treatment with glucocorticoids > 5 mg/d was significantly associated with an increased mortality, independent of disease activity. Significantly lower mortality was observed in patients treated with tumour necrosis factor α (TNFα) inhibitors (HRadj=0.64 (95% CI 0.50 to 0.81), rituximab (HRadj=0.57 (95% CI 0.39 to 0.84), or other biologics (HRadj=0.64 (95% CI 0.42 to 0.99), compared to those receiving methotrexate. To account for treatment termination in patients at risk, an HRadj for patients ever exposed to TNFα inhibitors or rituximab was calculated. This resulted in an HRadj of 0.77 (95% CI 0.60 to 0.97). Patients with long-standing high disease activity are at substantially increased risk of mortality. Effective control of disease activity decreases mortality. TNFα inhibitors and rituximab seem to be superior to conventional DMARDs in reducing this risk.
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影响因子：
27.4
作者：
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通讯作者：
Gomez-Reino, Juan J.
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Zink, Angela
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Eisen, Seth
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通讯作者：
BAUER, W
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作者：
Mikuls, Ted R.;Fay, Brian T.;Reimold, Andreas
通讯作者：
Reimold, Andreas