Dynamic Characteristics and Predictive Profile of Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients Commencing Glucocorticoids with csDMARD: A Real-World Experience.
Dynamic Characteristics and Predictive Profile of Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients Commencing Glucocorticoids with csDMARD: A Real-World Experience.
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DOI：
10.1007/s40744-022-00527-9
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发表时间：
2023-04
影响因子：
3.8
通讯作者：
Zhang, Zhuoli
中科院分区：
文献类型：
--
作者：
Xie, Wenhui;Huang, Hong;Zhang, Zhuoli
目前推荐糖皮质激素（GC）作为与传统合成缓解病情抗风湿药物（csDMARD）联合治疗类风湿性关节炎（RA）的过渡疗法，并应在临床可行的情况下尽快逐渐减量。我们的目的是探索开始 GC 并同时使用 csDMARD 的患者中 GC 终止的潜在预测因素。我们使用了来自真实世界纵向队列的数据。纳入了新开始 GC 并同时使用 csDMARD 的 RA 患者。根据3个月时疾病活动性较基线的变化程度，所有患者被分为四组（第1组：恶化或无下降；第2组：下降0-24.9%；第3组：下降25.0-49.9%；第4组：下降 ≥ 50.0%）。 Cox 回归用于估计危险风险 (HR)，置信区间 (CI) 为 95%。总体而言，207 名 RA 患者中，有 124 名根据风湿病专家的判断停止了 GC，其中 79.1% (91/115) 在 GC 停药后 6 个月内成功停止了 GC，且没有出现耀斑。 GC开始时年龄增加（HR 0.99，95% CI 0.98–1.00，p = 0.043）和同时使用非甾体抗炎药（HR 0.47，95% CI 0.25–0.88，p = 0.018）与GC戒断失败独立相关。此外，3个月时的疾病活动改善程度显着预测了随后GC停止的可能性（完全调整后的HR 1.35-1.47，p<0.01），第4组比第1组高2.38-3.59倍。将结果转换为成功停止GC而没有短期发作也得到了类似的结果。 3 个月时疾病活动改善程度独立预测随后的 GC 停药。这些发现表明动态治疗策略的重要性，密切关注 GC 减量和停药期间的疾病活动。在线版本包含可在 10.1007/s40744-022-00527-9 获取的补充材料。
Glucocorticoids (GC) are currently recommended as a bridging therapy in combination with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) for the treatment of rheumatoid arthritis (RA) and should be tapered as rapidly as clinically feasible. We aimed to explore potential predictors for GC discontinuation in patients commencing GC with concomitant csDMARD. We used data from a longitudinal real-world cohort. RA patients who newly started GC concomitantly with csDMARD were included. All patients were divided into four groups, according to degree of change in disease activity at 3 months from baseline (group 1: worsening or no decrease; group 2: 0–24.9% decrease; group 3: 25.0–49.9% decrease; group 4: ≥ 50.0% decrease). Cox regression was used to estimate hazard risk (HR) with 95% confidence interval (CI). In total, 124 out of 207 RA patients discontinued GC at the rheumatologist's discretion and 79.1% (91/115) of them successfully stopping GC without flare within 6 months after GC withdrawal. Increasing age (HR 0.99, 95% CI 0.98–1.00, p = 0.043) and concomitant nonsteroidal anti-inflammatory drugs use at GC initiation (HR 0.47, 95% CI 0.25–0.88, p = 0.018) were independently associated with GC withdrawal failure. Moreover, the degrees of disease activity improvement at 3 months significantly predicted the possibility of subsequent GC discontinuation (fully adjusted HR 1.35–1.47, p < 0.01), with 2.38–3.59 times higher in group 4 than group 1. Switching the outcome to successfully stopping GC without short-term flare yielded similar findings. The degrees of disease activity improvement at 3 months independently predicted the subsequent GC withdrawal. These findings suggest the importance of dynamic treatment strategies with a closer look at disease activity during GC tapering and discontinuation. The online version contains supplementary material available at 10.1007/s40744-022-00527-9.
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