Predictors of long-term clinical remission in rheumatoid arthritis.
Adult
Aged
Antirheumatic Agents
/ therapeutic use
Arthritis, Rheumatoid
/ drug therapy
Biological Products
/ therapeutic use
Female
Glucocorticoids
/ therapeutic use
Humans
Kaplan-Meier Estimate
Male
Medication Adherence
/ statistics & numerical data
Methotrexate
/ therapeutic use
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Remission Induction
Retrospective Studies
biologic agents
disease remission
effectiveness
glucocorticoids
methotrexate
rheumatoid arthritis
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
07
05
2020
revised:
17
07
2020
accepted:
20
07
2020
pubmed:
30
7
2020
medline:
4
11
2021
entrez:
30
7
2020
Statut:
ppublish
Résumé
Little is known about possible predictors of long-term survival on biologic disease-modifying antirheumatic drugs (bDMARD) after achievement of deep clinical remission in rheumatoid arthritis (RA) patients. We aimed at assessing factors associated with drug persistence of the first bDMARD in RA patients who achieved Simplified Disease Activity Index (SDAI) remission. The clinical charts of RA patients beginning a first bDMARD were retrospectively reviewed, and those who achieved SDAI-based remission were selected for this analysis. Drug retention rate and mean survival time (MST) were estimated using Kaplan-Meier curves, and hazard ratios (HRs) of discontinuing bDMARD were estimated by multivariate Cox-regression models. Eight-six patients were on SDAI remission, and the survival rate of bDMARDs since 'baseline-time' was 82.6% (MST = 77.8 (95% CI: 69-86) months). Once on remission, patients not taking concomitant glucocorticoids had significantly higher survival rate (90.7%, MST = 86.3 (95% CI: 78-95) months) than patients who continued to intake low dose of glucocorticoids (68.8%, MST = 56.9 (95% CI: 45-69) months; P = .008). On the contrary, those patients assuming methotrexate (MTX) had significantly higher survival (87.7% (MST = 81.8 (95% CI: 73-91) months) than patients who were not taking MTX (66.7% (MST = 55.3 (95% CI: 40-71) months) (log-rank 4.72, P = .03). After the achievement of disease remission, stopping glucocorticoids (HR 0.31, 95% CI: 0.10-0.93) and methotrexate co-therapy (HR 0.34, 95% CI: 0.12-0.98) were independently associated with a lower risk of bDMARD discontinuation. Among RA patients on clinical remission with a first bDMARD, those stopping glucocorticoids and continuing MTX had much longer survival on bDMARD.
Substances chimiques
Antirheumatic Agents
0
Biological Products
0
Glucocorticoids
0
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13363Informations de copyright
© 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.
Références
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