Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial.
Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial.
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DOI：
10.1136/rmdopen-2018-000676
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发表时间：
2018
期刊：
影响因子：
6.2
通讯作者：
Galloway J
中科院分区：
文献类型：
--
作者：
Bechman K;Sin FE;Ibrahim F;Norton S;Matcham F;Scott DL;Cope A;Galloway J
在特定的类风湿性关节炎（RA）患者中，逐渐减少抗肿瘤坏死因子（TNF）治疗似乎是可行、安全且有效的。抑郁在类风湿性关节炎中非常普遍，并可能通过多种机制影响耀斑的发生率。本研究旨在探讨心理状态是否能预测患者抗肿瘤坏死因子治疗剂量逐渐减少时的发作。本研究是对优化RA中TNF逐渐减少试验的事后分析，这是一项多中心、随机、开放标签的研究，研究持续低疾病活动度的RA患者的抗TNF逐渐减少。基线时收集患者报告的结果（健康评估问卷、EuroQol 5维量表、慢性疾病治疗功能评估疲劳量表（FACIT-F）、36项简短问卷调查（SF-36））。主要终点是耀斑，定义为28个关节计数增加疾病活动评分(DAS28)≥0.6和≥1个肿胀关节。离散时间生存模型用于确定患者报告的预测耀斑的结果。97名患者被随机分组，减少33%或66%的抗tnf剂量。41名患者突然发作。较高的基线DAS28评分与耀斑相关（调整后危险度1.96 (95% CI 1.18 ~ 3.24), p=0.01）。残疾（SF-36身体成分评分）、疲劳（FACIT-F）和心理健康（SF-36心理健康量表（MH））在未调整的模型中预测耀斑。在多变量分析中，只有sf - 36mh仍然是有统计学意义的耀斑预测因子（每10单位调整HR 0.74 (95% CI 0.60 ~ 0.93), p=0.01）。基线DAS28和精神健康状况与逐渐减少抗tnf治疗的患者的耀斑独立相关。疲劳和功能也与耀斑有关，但调整混杂因素后效果消失。鉴于这些发现，心理健康和功能状态应考虑在抗肿瘤坏死因子逐渐减少的决策，以优化成功的可能性。稿号：2010-020738-24；ISRCTN: 28955701;试。
Tapering of anti-tumour necrosis factor (TNF) therapy appears feasible, safe and effective in selected patients with rheumatoid arthritis (RA). Depression is highly prevalent in RA and may impact on flare incidence through various mechanisms. This study aims to investigate if psychological states predict flare in patients’ dose tapering their anti-TNF therapy. This study is a post-hoc analysis of the Optimizing TNF Tapering in RA trial, a multicentre, randomised, open-label study investigating anti-TNF tapering in RA patients with sustained low disease activity. Patient-reported outcomes (Health Assessment Questionnaire, EuroQol 5-dimension scale, Functional Assessment of Chronic Illness Therapy fatigue scale (FACIT-F), 36-Item Short Form Survey (SF-36)) were collected at baseline. The primary outcome was flare, defined as an increase in 28-joint count Disease Activity Score (DAS28) ≥0.6 and ≥1 swollen joint. Discrete-time survival models were used to identify patient-reported outcomes that predict flare. Ninety-seven patients were randomised to taper their anti-TNF dose by either 33% or 66%. Forty-one patients flared. Higher baseline DAS28 score was associated with flare (adjusted HR 1.96 (95% CI 1.18 to 3.24), p=0.01). Disability (SF-36 physical component score), fatigue (FACIT-F) and mental health (SF-36 mental health subscale (MH)) predicted flare in unadjusted models. In multivariate analyses, only SF-36 MH remained a statistically significant predictor of flare (adjusted HR per 10 units 0.74 (95% CI 0.60 to 0.93), p=0.01). Baseline DAS28 and mental health status are independently associated with flare in patients who taper their anti-TNF therapy. Fatigue and function also associate with flare but the effect disappears when adjusting for confounders. Given these findings, mental health and functional status should be considered in anti-TNF tapering decisions in order to optimise the likelihood of success. EudraCT Number: 2010-020738-24; ISRCTN: 28955701; Post-results.
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影响因子：
6.2
作者：
Bykerk, Vivian P.;Bingham, Clifton O.;Bartlett, Susan J.
通讯作者：
Bartlett, Susan J.
影响因子：
27.4
作者：
Rech J;Hueber AJ;Finzel S;Englbrecht M;Haschka J;Manger B;Kleyer A;Reiser M;Cobra JF;Figueiredo C;Tony HP;Kleinert S;Wendler J;Schuch F;Ronneberger M;Feuchtenberger M;Fleck M;Manger K;Ochs W;Schmitt-Haendle M;Lorenz HM;Nuesslein H;Alten R;Henes J;Krueger K;Schett G
通讯作者：
Schett G
影响因子：
4.9
作者：
Markusse IM;Dirven L;Gerards AH;van Groenendael JH;Ronday HK;Kerstens PJ;Lems WF;Huizinga TW;Allaart CF
通讯作者：
Allaart CF
影响因子：
5.5
作者：
Matcham, Faith;Davies, Rebecca;Galloway, James
通讯作者：
Galloway, James
影响因子：
--
作者：
DiMatteo, MR;Lepper, HS;Croghan, TW
通讯作者：
Croghan, TW