Sustained biologic-free and drug-free remission in rheumatoid arthritis, where are we now?
Sustained biologic-free and drug-free remission in rheumatoid arthritis, where are we now?
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DOI：
10.1186/s13075-015-0707-1
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发表时间：
2015-08-03
影响因子：
4.9
通讯作者：
van Vollenhoven RF
中科院分区：
文献类型：
--
作者：
Nagy G;van Vollenhoven RF
类风湿性关节炎的新药物和新治疗策略的出现使更多患者的病情得到缓解。此外，最近的临床试验和注册研究表明，一些最初需要积极治疗的患者可能会达到无生物制剂缓解，甚至达到治疗的最终目标，即无药物缓解，类似于康复。在这里，我们提出了一个话语审查的最重要的研究解决这些问题。根据总体结果，目前尚不清楚实现无生物制剂和无药物缓解主要是由于疾病的自然病程还是根据“机会之窗”假设进行的早期治疗干预。尽管仅在一小部分患者中可实现无药物缓解，但对该患者队列进行表征可提供有关有益预后因素和潜在机制的重要信息。总之，在一部分患者中，可以实现无生物制剂甚至无药物缓解;在实践中追求这些可能性可能会降低长期副作用的风险，并减轻疾病的经济负担。
The advent of new medications and new treatment strategies for rheumatoid arthritis has made it possible to achieve remission in more patients than before. Furthermore, recent clinical trials and register studies suggest that some patients who initially required aggressive therapy may achieve biologic-free remission or even the ultimate goal of therapy, drug-free remission, resembling recovery. Here, we present a discursive review of the most important studies addressing these issues. Based on the overall results, it remains unclear if achieving biologic-free and drug-free remissions are primarily due to the natural course of the disease or to the early therapeutic intervention according to the ‘window of opportunity’ hypothesis. Although medication-free remission is only achievable in a small subset of patients, characterizing this patient cohort may provide important information about beneficial prognostic factors and the underlying mechanisms. In summary, in a subset of patients biologic-free and even drug-free remission can be achieved; pursuing these possibilities in practice may decrease the risk for long-term side effects and attenuate the economic burden of the disease.