Predictors of response to anti-TNF therapy in RA patients with moderate or high DAS28 scores
Predictors of response to anti-TNF therapy in RA patients with moderate or high DAS28 scores
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DOI：
10.1016/j.jbspin.2013.04.005
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发表时间：
2014-01-01
期刊：
影响因子：
4.2
通讯作者：
Sarzi-Puttini, Piercarlo
中科院分区：
文献类型：
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作者：
Atzeni, Fabiola;Bongiovanni, Sara;Sarzi-Puttini, Piercarlo
目的：确定在LORHEN登记的类风湿关节炎(RA)患者接受抗肿瘤坏死因子药物治疗5年后预测良好临床疗效的临床因素，并根据他们的基线DAS28评分将其分为两组(中等和中等；3.2-5.1[MDA]和高>；5.1[HDA])。方法：用DAS28评估基线和12个月后的疾病活动性，并使用EULAR改善标准评估疗效。结果：本研究包括1300名确诊的类风湿关节炎患者：975名HDA和325名MDA。平均36个月后，29.6%的患者DAS28评分小于或等于2.6%(HDA25.8%vs.MDA43.0%；P<；0.001)，并被认为是缓解期。慢性再生障碍性贫血患者EULAR反应良好的概率较高与男性(女性vs.M-OR0.45，95%可信区间0.26-0.78；P：0.004)、开始治疗时年龄较低(OR0.98，95%可信区间0.96-0.99；P：0.002)、无合并症(OR0.18，95%可信区间0.06-0.52；P：0.002)或以前未使用皮质类固醇(OR1.92，95%可信区间1.14-3.22；与英夫利昔单抗比较(OR2.21，95%CI1.37~3.57；P 0.001)，丙二醛患者EULAR良好反应的概率与男性相关(F vs.M-OR0.39，95%CI0.17~0.90；P：0.027)。(C)2013年法国兴业银行。爱思唯尔·马森公司出版。版权所有。
Objectives: To identify the clinical factors predicting a good clinical response to anti-TNF therapy in rheumatoid arthritis (RA) patients entered in the LORHEN registry after 5 years of treatment with anti-TNF agents and divided into two groups on the basis of their baseline DAS28 scores (moderate >3.2-5.1 [MDA] and high > 5.1 [HDA]).Methods: Disease activity at baseline and after 12 months was assessed using the DAS28, and response was evaluated using the EULAR improvement criteria.Results: The study involved 1300 patients with established RA: 975 with HDA and 325 with MDA. After a mean 36-month, 29.6% of the patients had a DAS28 score of less or equal to 2.6 (HDA 25.8% vs. MDA 43.0%; P < 0.001) and were considered to be in remission. A higher probability of a good EULAR response in patients with HDA was associated with male gender (F vs. M - OR 0.45, 95% CI 0.26-0.78; P: 0.004), lower age at the start of treatment (OR 0.98, 95% CI 0.96-0.99; P: 0.002), the absence of comorbidities (OR 0.18, 95% CI 0.06-0.52; P: 0.002) or no previous use of corticosteroids (OR 1.92, 95% CI 1.14-3.22; P: 0.015) and the use of adalimumab vs. infliximab (OR 2.21, 95% CI 1.37-3.57; P 0.001); in patients with MDA, the probability of a good EULAR response was associated with male gender (F vs. M - OR 0.39, 95% CI 0.17-0.90; P: 0.027).Conclusions: With the exception of male gender, the factors predicting a good EULAR response are different in patients with MDA and those with HDA. (C) 2013 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.