Prediction of primary non-response to methotrexate therapy using demographic, clinical and psychosocial variables: results from the UK Rheumatoid Arthritis Medication Study (RAMS).
Prediction of primary non-response to methotrexate therapy using demographic, clinical and psychosocial variables: results from the UK Rheumatoid Arthritis Medication Study (RAMS).
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DOI：
10.1186/s13075-018-1645-5
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发表时间：
2018-07-13
影响因子：
4.9
通讯作者：
Verstappen SMM
中科院分区：
文献类型：
--
作者：
Sergeant JC;Hyrich KL;Anderson J;Kopec-Harding K;Hope HF;Symmons DPM;RAMS Co-Investigators;Barton A;Verstappen SMM
甲氨蝶呤(MTX)仍然是类风湿性关节炎(RA)的首选抗风湿药物，但反应各不相同。预测对MTX的无应答可以使人们更早地获得替代或附加药物，并控制疾病进展。我们的目标是识别MTX无应答的基线预测因素，并将其结合到预测算法中。这项研究纳入了类风湿性关节炎药物研究(RAMS)的患者，这是一项英国多中心前瞻性观察研究，首次开始使用MTX，研究对象是RA或未分化多发性关节炎患者。根据欧洲风湿病联盟(EULAR)的反应标准，6个月后对MTX无反应的定义为“无反应”、因无效而停止MTX或开始生物治疗。使用Logistic回归分析基线人口统计学、临床和心理社会预测因素与无反应之间的关系。使用接收器工作特性曲线(AUC)下的面积和校准曲线图来评估预测性能。在1050名患者中，449名(43%)被归类为无应答者。MTX无反应(OR(95%CI))的独立多变量预测因素为类风湿因子(RF)阴性(0.62(0.45，0.86)阳性与阴性)、较高的健康评估问卷评分(1.64(1.25，2.15))、较高的压痛关节数(1.06(1.02，1.10))、28个关节的较低疾病活动评分(0.29(0.23，0.39))和较高的医院焦虑和抑郁量表焦虑评分(1.07(1.03，1.12))。乐观修正后的AUC为0.74。这是在一项对开始MTX的患者的大型当代研究中开发的第一个MTX无反应模型，在该研究中考虑了人口统计学、临床和心理社会预测因素。患者焦虑是无反应的预测因子，可以在治疗开始时解决。本文的在线版本(10.1186/s13075-018-1645-5)包含补充材料，可供授权用户使用。
Methotrexate (MTX) remains the disease-modifying anti-rheumatic drug of first choice in rheumatoid arthritis (RA) but response varies. Predicting non-response to MTX could enable earlier access to alternative or additional medications and control of disease progression. We aimed to identify baseline predictors of non-response to MTX and combine these into a prediction algorithm. This study included patients recruited to the Rheumatoid Arthritis Medication Study (RAMS), a UK multi-centre prospective observational study of patients with RA or undifferentiated polyarthritis, commencing MTX for the first time. Non-response to MTX at 6 months was defined as “no response” using the European League Against Rheumatism (EULAR) response criteria, discontinuation of MTX due to inefficacy or starting biologic therapy. The association of baseline demographic, clinical and psychosocial predictors with non-response was assessed using logistic regression. Predictive performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. Of 1050 patients, 449 (43%) were classified as non-responders. Independent multivariable predictors of MTX non-response (OR (95% CI)) were rheumatoid factor (RF) negativity (0.62 (0.45, 0.86) for RF positivity versus negativity), higher Health Assessment Questionnaire score (1.64 (1.25, 2.15)), higher tender joint count (1.06 (1.02, 1.10)), lower Disease Activity score in 28 joints (0.29 (0.23, 0.39)) and higher Hospital Anxiety and Depression Scale anxiety score (1.07 (1.03, 1.12)). The optimism-corrected AUC was 0.74. This is the first model for MTX non-response to be developed in a large contemporary study of patients commencing MTX in which demographic, clinical and psychosocial predictors were considered. Patient anxiety was a predictor of non-response and could be addressed at treatment commencement. The online version of this article (10.1186/s13075-018-1645-5) contains supplementary material, which is available to authorized users.
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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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