Prevalence and predictors of sustained remission/low disease activity after discontinuation of induction or maintenance treatment with tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic and scoping review.
Prevalence and predictors of sustained remission/low disease activity after discontinuation of induction or maintenance treatment with tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic and scoping review.
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DOI：
10.1186/s13075-023-03199-0
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发表时间：
2023-11-20
影响因子：
4.9
通讯作者：
中科院分区：
文献类型：
--
作者：
分别在诱导治疗和维持治疗研究中，确定类风湿关节炎（RA）患者停用肿瘤坏死因子抑制剂（TNFi）后持续缓解/低疾病活动度（LDA）的患病率，并确定成功停药的预测因素。我们对2005年至2022年5月发表的研究进行了系统性文献综述，这些研究报告了缓解/LDA患者停用TNFi后的结局。我们通过诱导或维持治疗、缓解标准和随访时间计算成功停药的发生率。我们对成功停药的预测因素进行了范围审查。确定了22项诱导-退出研究。在汇总分析中，停药后37-52周，58%（95%置信区间（CI）45，70）的DAS 28 < 3.2（9项研究），52%（95% CI 35，69）的DAS 28 < 2.6（9项研究），40%（95% CI 18，64）的SDAI ≤ 3.3（4项研究）。在继续TNFi治疗的患者中，62%至85%的患者维持缓解。还确定了22项维持治疗中止的研究。在TNFi停药后37-52周，48%（95% CI 38，59）的DAS 28 < 3.2（10项研究），47%（95% CI 33，62）的DAS 28 < 2.6（6项研究）。研究间的异质性很高。诱导-戒断研究中的预测因素数据有限。在两种治疗方案中，RA持续时间较长与停药成功率较低最一致。大约一半的RA患者在TNFi停药后保持缓解/LDA长达1年，诱导-停药环境中的比例略高于维持治疗停药。在线版本包含补充材料，可通过10.1186/s13075-023-03199-0获得。
To determine the prevalence of sustained remission/low disease activity (LDA) in patients with rheumatoid arthritis (RA) after discontinuation of tumor necrosis factor inhibitors (TNFi), separately in induction treatment and maintenance treatment studies, and to identify predictors of successful discontinuation. We performed a systematic literature review of studies published from 2005 to May 2022 that reported outcomes after TNFi discontinuation among patients in remission/LDA. We computed prevalences of successful discontinuation by induction or maintenance treatment, remission criterion, and follow-up time. We performed a scoping review of predictors of successful discontinuation. Twenty-two induction-withdrawal studies were identified. In pooled analyses, 58% (95% confidence interval (CI) 45, 70) had DAS28 < 3.2 (9 studies), 52% (95% CI 35, 69) had DAS28 < 2.6 (9 studies), and 40% (95% CI 18, 64) had SDAI ≤ 3.3 (4 studies) at 37–52 weeks after discontinuation. Among patients who continued TNFi, 62 to 85% maintained remission. Twenty-two studies of maintenance treatment discontinuation were also identified. At 37–52 weeks after TNFi discontinuation, 48% (95% CI 38, 59) had DAS28 < 3.2 (10 studies), and 47% (95% CI 33, 62) had DAS28 < 2.6 (6 studies). Heterogeneity among studies was high. Data on predictors in induction-withdrawal studies were limited. In both treatment scenarios, longer duration of RA was most consistently associated with less successful discontinuation. Approximately one-half of patients with RA remain in remission/LDA for up to 1 year after TNFi discontinuation, with slightly higher proportions in induction-withdrawal settings than with maintenance treatment discontinuation. The online version contains supplementary material available at 10.1186/s13075-023-03199-0.
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影响因子：
4.6
作者：
Nagatani K;Sakashita E;Endo H;Minota S
通讯作者：
Minota S
影响因子：
4.6
作者：
Kameda H;Hirata A;Katagiri T;Takakura Y;Inoue Y;Takenaka S;Ito H;Mizushina K;Ogura T
通讯作者：
Ogura T
DOI：
10.1002/art.40196
发表时间：
2017-10
期刊：
Arthritis & rheumatology (Hoboken, N.J.)
影响因子：
--
作者：
Weinblatt ME;Bingham CO 3rd;Burmester GR;Bykerk VP;Furst DE;Mariette X;van der Heijde D;van Vollenhoven R;VanLunen B;Ecoffet C;Cioffi C;Emery P
通讯作者：
Emery P
影响因子：
3.1
作者：
Burkard T;Williams RD;Vallejo-Yagüe E;Hügle T;Finckh A;Kyburz D;Burden AM
通讯作者：
Burden AM