Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study
Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study
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DOI：
10.1136/ard.2010.147751
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发表时间：
2011-08-01
影响因子：
27.4
通讯作者：
Allaart, C. F.
中科院分区：
文献类型：
--
作者：
van den Broek, M.;Klarenbeek, N. B.;Allaart, C. F.
目的描述早期类风湿性关节炎患者停止英夫利西单抗治疗后的病程，并确定持续低疾病活动度的预测因素。方法在BeSt研究的事后分析中，观察甲氨蝶呤联合英夫利西单抗治疗的患者的疾病活动度和关节损伤进展，在达到低疾病活动度（DAS = 2.4）后停用英夫利西单抗6个月。预测因素采用考克斯回归分析。结果104例患者停用英夫利昔单抗，其中77例接受英夫利昔单抗加甲氨蝶呤作为初始治疗。英夫利昔单抗停药时的平均DAS为1.3，中位症状持续时间为23个月，中位Sharp/货车derHeijde评分为5.5。中位随访时间为7.2年。英夫利西单抗在48%的患者在中位17个月后疾病活动度降低后重新引入。关节损伤进展率在停药后的一年中没有增加，无论是否复发。在重新引入英夫利昔单抗后，这些患者中的84%再次达到DAS = 2.4。在多变量模型中，吸烟，英夫利昔单抗治疗持续时间= 18个月和共享表位（SE）与英夫利昔单抗的重新引入独立相关：6%的非吸烟，SE阴性患者治疗< 18个月需要英夫利昔单抗re-introduction.Conclusion英夫利昔单抗的停止是成功的52%，在数字上更高的成功率在患者最初治疗英夫利昔单抗。在48%发作的患者中，84%的患者恢复了低疾病活动性。关节损伤进展率在停药后的一年内没有增加。吸烟、英夫利昔单抗治疗持续时间长和SE与重新引入英夫利昔单抗独立相关。
Objective To describe the disease course after the cessation of infliximab in early rheumatoid arthritis patients with disease activity score (DAS)-steered treatment and to identify predictors of persistent low disease activity.Methods In a post-hoc analysis of the BeSt study, disease activity and joint damage progression were observed in patients treated with methotrexate plus infliximab, who discontinued infliximab after achieving low disease activity (DAS = 2.4) for 6 months. Predictors were identified using Cox regression analysis.Results 104 patients discontinued infl iximab, of whom 77 had received infl iximab plus methotrexate as initial treatment. Mean DAS at the time of infl iximab cessation was 1.3, median symptom duration was 23 months and median Sharp/van derHeijde score was 5.5. The median follow-up was 7.2 years. Infliximab was re-introduced after loss of low disease activity in 48%, after a median of 17 months. The joint damage progression rate did not increase in the year after cessation, regardless of flare. After re-introduction of infl iximab, 84% of these patients again achieved a DAS = 2.4. In the multivariable model, smoking, infl iximab treatment duration = 18 months and shared epitope (SE) were independently associated with the re-introduction of infl iximab: 6% of the non-smoking, SE-negative patients treated < 18 months needed infl iximab re-introduction.Conclusion Cessation of infl iximab was successful in 52%, with numerically higher success rates in patients initially treated with infl iximab. Of the 48% who flared, 84% regained low disease activity. The joint damage progression rate did not increase in the year after cessation. Smoking, long infl iximab treatment duration and SE were independently associated with re-introduction of infl iximab.