Sustained Remission in Patients With Rheumatoid Arthritis Receiving Triple Therapy Compared to Biologic Therapy: A Swedish Nationwide Register Study
Sustained Remission in Patients With Rheumatoid Arthritis Receiving Triple Therapy Compared to Biologic Therapy: A Swedish Nationwide Register Study
复制标题
风湿性关节炎患者接受三联疗法与生物疗法的持续缓解比较：一项瑞典全国注册研究
DOI：
10.1002/art.41720
复制
发表时间：
2021-05-10
影响因子：
13.3
通讯作者：
Kapetanovic, Meliha C.
中科院分区：
文献类型：
--
作者：
Kallmark, Hanna;Einarsson, Jon T.;Kapetanovic, Meliha C.
目的比较生物治疗（生物疾病改善抗风湿药物加甲氨蝶呤[MTX]）与三联治疗（MTX +磺胺氮嗪+羟氯喹/氯喹）对类风湿性关节炎（RA）持续缓解的现实疗效。方法纳入2000年至2012年期间在瑞典风湿病质量登记处登记的RA患者，这些患者在MTX单药治疗后接受生物或三联治疗作为第一治疗策略。持续缓解定义为28个关节的疾病活动评分(DAS28) = 6个月（短期持续缓解）或>= 24个月（长期持续缓解）。使用倾向评分调整回归分析，比较治疗组在治疗期间、1年和2年(1)所有患者开始治疗和2)患者继续接受治疗时的情况。此外，生存分析用于在随访期间的任何时间比较治疗组，而不考虑治疗保留。结果共纳入1502例患者，其中生物治疗组1155例，三联治疗组347例。对于开始治疗的患者，在开始生物治疗与三联治疗后1年实现短期和长期缓解的调整优势比（ORs）分别为1.79（95%可信区间[95% CI] 1.18-2.71）和1.86 （95% CI 1.00-3.48）。2年时，or分别为1.92 （95% CI 1.21-3.06）和1.62 （95% CI 0.94-2.79）。对于继续接受治疗的患者，1年的相应结果为1.12 （95% CI 0.72-1.75）和1.1 (95% CI 0.59-2.16)；2年时，分别为0.85 （95% CI 0.49-1.47）和0.76 （95% CI 0.41-1.39）。随访期间任何时间的短期和长期持续缓解的风险比分别为1.15 （95% CI 0.91-1.46）和1.09 （95% CI 0.77-1.54）。结论在开始生物疗法或三联疗法的患者中，生物疗法更能有效地维持治疗并获得持续缓解。然而，在继续接受治疗的患者中，以及在随访期间的任何时间，无论是否保留治疗，获得持续缓解的概率相似。虽然生物疗法达到持续缓解的可能性更高，但对于某些RA患者，三联疗法可能仍然是生物疗法的替代方案，而不会妨碍未来获得持续缓解的机会。
Objective To compare the real-life effectiveness of biologic therapy (a biologic disease-modifying antirheumatic drug plus methotrexate [MTX]) versus triple therapy (MTX plus sulfasalazine plus hydroxychloroquine/chloroquine) for sustained remission of rheumatoid arthritis (RA).Methods RA patients who were registered in the nationwide Swedish Rheumatology Quality Register between 2000 and 2012 and were receiving biologic or triple therapy as a first treatment strategy after MTX monotherapy were included. Sustained remission was defined as a Disease Activity Score in 28 joints (DAS28) of = 6 months (short-term sustained remission) or for >= 24 months (long-term sustained remission). Treatment groups were compared during treatment, at 1 year, and at 2 years for 1) all patients starting therapy and 2) patients continuing to receive therapy, using propensity score-adjusted regression analyses. In addition, survival analyses were used to compare treatment groups at any time during follow-up irrespective of therapy retention.Results A total of 1,502 patients were included (1,155 receiving biologic therapy and 347 receiving triple therapy). For patients starting therapy, the adjusted odds ratios (ORs) of achieving short-term and long-term remission, respectively, at 1 year after start of biologic therapy versus triple therapy were 1.79 (95% confidence interval [95% CI] 1.18-2.71) and 1.86 (95% CI 1.00-3.48). At 2 years, the ORs were 1.92 (95% CI 1.21-3.06) and 1.62 (95% CI 0.94-2.79), respectively. For patients continuing to receive therapy, corresponding results at 1 year were 1.12 (95% CI 0.72-1.75) and 1.1 (95% CI 0.59-2.16); at 2 years, 0.85 (95% CI 0.49-1.47) and 0.76 (95% CI 0.41-1.39). Hazard ratios for short-term and long-term sustained remission at any time during follow-up were 1.15 (95% CI 0.91-1.46) and 1.09 (95% CI 0.77-1.54), respectively.Conclusion Among patients starting biologic or triple therapy, biologic therapy was more effective for remaining on therapy and achieving sustained remission. However, similar probabilities were found for achieving sustained remission among patients remaining on therapy and at any time during follow-up irrespective of therapy retention. Although the likelihood of reaching sustained remission is higher with biologic therapy, for certain RA patients triple therapy may still be an alternative to biologic therapy without hampering future chances of obtaining sustained remission.