Importance of methotrexate therapy concomitant with tocilizumab treatment in achieving better clinical outcomes for rheumatoid arthritis patients with high disease activity: an observational cohort study
Importance of methotrexate therapy concomitant with tocilizumab treatment in achieving better clinical outcomes for rheumatoid arthritis patients with high disease activity: an observational cohort study
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DOI：
10.1093/rheumatology/keu302
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发表时间：
2015-01-01
期刊：
影响因子：
5.5
通讯作者：
Ishiguro, Naoki
中科院分区：
文献类型：
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作者：
Kojima, Toshihisa;Yabe, Yuichiro;Ishiguro, Naoki
方法.从多中心鹤井生物制品通讯登记处共选择了240例接受TCZ治疗的RA患者。通过逻辑回归分析确定52周时缓解的预测基线因素[28项DAS（DAS 28）< 2.6]。为了确认相关性是否随基线疾病活动水平而变化，我们还评估了包括相互作用项（每个基线变量x DAS 28）的模型。总共有49.3%的研究参与者使用MTX和TCZ。即使在控制基线DAS 28后，疾病持续时间也较短（千分之一货币符号3年）[比值比（OR）3.58（95% CI 1.81，7.07）]，结构性损伤较少[Steinbroker阶段a千分之一货币符号II，或2.33（95% CI 1.32，4.12）]和伴随使用泼尼松龙[OR 0.38（95% CI 0.21，0.68）]显示缓解的显著预测值。合并使用MTX未显示与缓解的显著相关性，而在合并使用MTX x DAS之间观察到显著的相互作用28（P = 0.006）。在基线疾病活动度高（DAS 28> 5.1）的患者中，合并使用MTX与缓解几率增加相关[所有基线变量的校正OR为2.54（95%CI 1.11，5.83）]，而在基线疾病活动度低至中度的患者中，两者之间无相关性（DAS 28 a千分之一货币符号5.1）。合并使用MTX是TCZ治疗高疾病活动性RA患者的重要组成部分。
Methods. A total of 240 RA patients who received TCZ were selected from the multicentre Tsurumai Biologics Communication Registry. Predictive baseline factors for remission [28-item DAS (DAS28) < 2.6] at 52 weeks were determined by logistic regression analysis. To confirm whether the associations varied by the level of baseline disease activity, we also assessed the model including the interaction term (each baseline variable x DAS28).Results. In total, 49.3% of the study participants used MTX with TCZ. Even after controlling for the baseline DAS28, shorter disease duration (a parts per thousand currency sign3 year) [odds ratio (OR) 3.58 (95% CI 1.81, 7.07)], less structural damage [Steinbroker stage a parts per thousand currency signII, OR 2.33 (95% CI 1.32, 4.12)] and concomitant prednisolone use [OR 0.38 (95% CI 0.21, 0.68)] showed significant predictive values for remission. Concomitant MTX use failed to show a significant association with remission, whereas a significant interaction was observed among concomitant MTX use x DAS28 (P = 0.006). In patients with high baseline disease activity (DAS28 > 5.1), concomitant MTX use was associated with increased odds for remission [adjusted OR for all baseline variables 2.54 (95% CI 1.11, 5.83)], while no association was indicated between them in patients with low to moderate baseline disease activity (DAS28 a parts per thousand currency sign 5.1).Conclusion. Concomitant MTX use is an important component of TCZ treatment for RA patients with high disease activity.