Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.
Discontinuation of adalimumab after achieving remission in patients with established rheumatoid arthritis: 1-year outcome of the HONOR study.
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DOI：
10.1136/annrheumdis-2013-204016
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发表时间：
2015-02
影响因子：
27.4
通讯作者：
Saito K
中科院分区：
文献类型：
--
作者：
Tanaka Y;Hirata S;Kubo S;Fukuyo S;Hanami K;Sawamukai N;Nakano K;Nakayamada S;Yamaoka K;Sawamura F;Saito K
旨在研究停用阿达木单抗 (ADA) 1 年而不出现复发（DAS28-红细胞沉降率 (ESR) ≥3.2）的可能性，并确定使已确诊的类风湿性关节炎 (RA) 患者保持不使用 ADA 的因素。在 197 名接受 ADA + 甲氨蝶呤 (MTX) 治疗的 RA 患者中，75 名符合无 ADA 标准（无类固醇且使用稳定的 MTX 剂量持续 DAS28-ESR 缓解 6 个月）的患者接受了为期 1 年的研究。 75 名患者的平均病程和 DAS28-ESR 评分在基线时分别为 7.5 年和 5.1。 ADA 停用组中持续 DAS28-ESR <2.6 (48%) 和 DAS28-ESR <3.2 (62%) 1 年的患者比例显着低于 ADA 继续组；然而，在逻辑分析后通过接受者操作特征分析确定的深度缓解（DAS28-ESR≤1.98）的患者中，这些比率分别增加至68％和79％，两组之间没有显着差异。值得注意的是，对急性发作患者重新给予 ADA 可以有效地将 90% 的患者的 DAS28-ESR 在 6 个月内恢复到 <3.2，100% 的患者在 9 个月内将 DAS28-ESR 恢复到 <3.2。在 ADA 停药期间持续 DAS28-ESR <3.2 的患者中，100% 保持结构性缓解，94% 保持功能性缓解。在已确诊的 RA 患者中证明了 1 年内不使用 ADA 的可能性，结果是 79% 的深度缓解患者可以停用 ADA 而不会出现复发，ADA 继续治疗组的比率相似，并且 DAS28-ESR <3.2 的患者没有出现功能或结构损伤。在 ADA 停药期间，对出现急性发作的患者重新给予 ADA 是有效的。
To investigate the possibility of discontinuing adalimumab (ADA) for 1 year without flaring (DAS28-erythrocyte sedimentation rate (ESR) ≥3.2), and to identify factors enabling established patients with rheumatoid arthritis (RA) to remain ADA-free. Of 197 RA patients treated with ADA+methotrexate (MTX), 75 patients who met the ADA-free criteria (steroid-free and sustained DAS28-ESR remission for 6 months with stable MTX doses) were studied for 1 year. The mean disease duration and DAS28-ESR score in 75 patients was 7.5 years and 5.1 at baseline, respectively. The proportion of patients who sustained DAS28-ESR <2.6 (48%) and DAS28-ESR <3.2 (62%) for 1 year were significantly lower in the ADA discontinuation group than in the ADA continuation group; however, in patients with deep remission (DAS28-ESR ≤1.98) identified by receiver operating characteristics analysis following logistic analysis, these rates increased to 68% and 79%, respectively, with no significant difference between both groups. Remarkably, ADA readministration to patients with flare was effective in returning DAS28-ESR to <3.2 within 6 months in 90% and 9 months in 100% patients; among the patients who sustained DAS28-ESR <3.2 during ADA discontinuation, 100% remained in structural remission and 94% in functional remission. The possibility of remaining ADA-free for 1 year was demonstrated in established patients with RA with outcomes that ADA can be discontinued without flaring in 79% patients with deep remission, with similar rates in the ADA continuation group, and showed no functional or structural damage in patients with DAS28-ESR <3.2. ADA readministration to patients with flare during ADA discontinuation was effective.
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