Timing and Impact of Decisions to Adjust Disease-Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease.
Timing and Impact of Decisions to Adjust Disease-Modifying Antirheumatic Drug Therapy for Rheumatoid Arthritis Patients With Active Disease.
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DOI：
10.1002/acr.23418
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发表时间：
2018-06
影响因子：
4.7
通讯作者：
Roberts MS
中科院分区：
文献类型：
--
作者：
Shaw Y;Chang CH;Levesque MC;Donohue JM;Michaud K;Roberts MS
指南建议具有中度至高度疾病活动度（MHDAS）的类风湿性关节炎（RA）患者至少每3个月调整一次疾病缓解抗风湿药物（DMARD）治疗，直至达到低疾病活动度或缓解（LDAS）。我们研究了患有MHDAS的RA患者在临床实践中调整DMARD治疗的速度，以及那些在90天内调整DMARD以应对MHDAS的患者是否更早达到LDAS。我们在匹兹堡大学风湿性关节炎比较有效性研究（RACER）登记处确定了患有MHDAS的RA患者，并对DMARD治疗调整时间进行了竞争风险回归，对LDAS时间进行了考克斯回归。我们确定了538例合格受试者，随访时间为943.5患者年。60%的持续性MHDAS患者在90天内调整了DMARD。在所有受试者中，至DMARD调整和LDAS的中位时间分别为154 [IQR：1-706]天和301 [140-706]天。老年人（亚分布风险比（SHR）=0.61，p=0.02）、基线疾病活动度较低（SHR=0.72，p<0.01）、RA持续时间较长（SHR=0.98，p<0.01）和生物制品使用（SHR=0.71，p<0.01）与治疗调整时间较长显著相关。非裔美国人（HR=0.63，p=0.01）、基线疾病活动度较高（HR=0.75，p<0.01）和90天内未调整DMARD治疗（HR=0.76，p=0.01）与LDAS时间较长相关。在90天内调整DMARDs与更短的LDAS时间相关，但许多持续性MHDAS患者等待超过90天才调整DMARDs。需要采取干预措施来解决MHDAS RA患者DMARD调整的及时性。
Guidelines recommend that rheumatoid arthritis (RA) patients with moderate to high disease activity (MHDAS) adjust disease-modifying antirheumatic drug (DMARD) therapy at least every 3 months until reaching low disease activity or remission (LDAS). We examined how quickly RA patients with MHDAS adjust DMARD therapy in clinical practice, and whether those who adjust DMARDs within 90 days in response to MHDAS reach LDAS sooner. We identified RA patients with MHDAS in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry, and conducted a competing risks regression on time to DMARD therapy adjustment and a Cox regression on time to LDAS. We identified 538 eligible subjects with 943.5 patient-years of follow-up. Sixty percent of patients with persistent MHDAS adjusted DMARDs within 90 days. Among all subjects, median times to DMARD adjustment and LDAS were 154 [IQR: 1–706] and 301 [140–706] days, respectively. Being elderly (subdistribution hazard ratio (SHR)=0.61, p=0.02), lower baseline disease activity (SHR=0.72, p<0.01), longer duration of RA (SHR=0.98, p<0.01), and biologic use (SHR=0.71, p<0.01) were significantly associated with longer times to therapy adjustment. African-American race (HR=0.63, p=0.01), higher baseline disease activity (HR=0.75, p<0.01), and not adjusting DMARD therapy within 90 days (HR=0.76, p=0.01) were associated with longer times to LDAS. Adjusting DMARDs within 90 days was associated with shorter times to LDAS, but many patients with persistent MHDAS waited more than 90 days to adjust DMARDs. Interventions are needed to address the timeliness of DMARD adjustments for RA patients with MHDAS.
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影响因子：
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作者：
Constantinescu, Florina;Goucher, Suzanne;Weinstein, Arthur;Smith, Wally;Fraenkel, Liana
通讯作者：
Fraenkel, Liana
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
3.9
作者：
Bykerk, Vivian P.;Shadick, Nancy;Solomon, Daniel H.
通讯作者：
Solomon, Daniel H.
DOI：
10.1158/1078-0432.ccr-11-2097
发表时间：
2012-04-15
期刊：
Clinical cancer research : an official journal of the American Association for Cancer Research
影响因子：
--
作者：
Dignam JJ;Zhang Q;Kocherginsky M
通讯作者：
Kocherginsky M
影响因子：
4.9
作者：
Markusse IM;Dirven L;Gerards AH;van Groenendael JH;Ronday HK;Kerstens PJ;Lems WF;Huizinga TW;Allaart CF
通讯作者：
Allaart CF