Effectiveness and safety of treat-to-target strategy in elderly-onset rheumatoid arthritis: a 3-year prospective observational study
Effectiveness and safety of treat-to-target strategy in elderly-onset rheumatoid arthritis: a 3-year prospective observational study
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DOI：
10.1093/rheumatology/keaa922
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发表时间：
2021-01-30
期刊：
影响因子：
5.5
通讯作者：
Harigai, Masayoshi
中科院分区：
文献类型：
--
作者：
Sugihara, Takahiko;Ishizaki, Tatsuro;Harigai, Masayoshi
目的评价老年发作类风湿关节炎（EORA）患者采用低疾病活动度的达标治疗（T2 T）策略的3年疗效，并证实T2 T的安全性。随后在197例中高度疾病活动性的MTX初治EORA患者（平均年龄74.9岁）中使用生物DMARD（bDMARD）。在第12、24、36、52、76、104和128周评价T2 T未实施。结果在观察期内，甲氨蝶呤、糖皮质激素和DMARDs联合应用的比例分别为84.7%、34.0%和41.6%。197例患者中有69例由于合并症或患者自己的决定而未能坚持T2 T：33例失败1次，19例失败2次，10例失败3次，6例失败4次或以上。简化疾病活动指数（SDAI）缓解和HAQ残疾指数（HAQ-DI）
Objectives To evaluate 3-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity for patients with elderly-onset RA (EORA) and to confirm safety profile of T2T.Methods Treatment was adjusted to target low disease activity with conventional synthetic DMARDs, followed by biologic DMARDs (bDMARDs) in 197 MTX-naive EORA patients (mean age 74.9years) with moderate-to-high disease activity. Non-implementation of T2T was evaluated at week 12, 24, 36, 52, 76, 104 and 128. To evaluate risks of using MTX, bDMARDs and glucocorticoids, 2122 periods of 3months each were analysed using Bayesian hierarchical logistic regression models.Results Of the patients, 84.7% received methotrexate, 34.0% glucocorticoids with DMARDs and 41.6% bDMARDs during the observation period. Sixty-nine of the 197 patients failed to adhere to T2T because of comorbidities or the patient's own decision: 33 failed once, 19 twice, 10 three times and 6 four times or more. Simplified disease activity index (SDAI) remission and HAQ Disability Index (HAQ-DI)