JAMA:传统合成改善病情抗风湿药维持治疗药物剂量对复发风险的影响

2021-05-07 MedSci原创 MedSci原创

对于接受传统合成改善病情抗风湿药后病情缓解的类风湿性关节炎患者,维持治疗期间药物剂量减少一半后,复发风险增加,不支持剂量减半方案用于RA患者的维持治疗

类风湿性关节炎(RA)是一种慢性炎症性疾病,其特征是关节炎症,可导致关节损伤和身体功能受损。虽然无法治愈,但可以通过持续的免疫调节来控制病情。传统合成改善病情抗风湿药(csDMARDs)主要包括甲氨蝶呤(MTX)、柳氮磺吡啶(SSZ)、来氟米特(LEF)等,多数患者在接受csDMARDs可实现持续缓解,但维持治疗方案仍存在一定争议。近日研究人员考察了已实现持续缓解的RA患者中,csDMARDs逐渐减少与继续维持治疗相比,对复发风险的影响

ARCTIC REWIND是一项多中心、随机、平行、开放非劣效性研究,在挪威10家医院开展,共有160名接受稳定csDMARD治疗后,RA缓解12个月的患者参与,随机接受先前一半剂量csDMARDs药物的维持剂量治疗(n=80)或保持先前的剂量不变(n=80),随访12个月。研究的主要终点为疾病复发的患者比例,定义为疾病活动评分(DAS)大于1.6,DAS评分增加0.6单位或以上, 2个关节或以上肿胀。

患者平均年龄55.1岁,66%为女性,155人完成随访被纳入主要分析,减半组77人,维持剂量组78人。csDMARD剂量减半组有19例(25%)患者出现复发,而csDMARD剂量稳定组仅有5例(6%),风险差异为18%,未达到非劣性终点。剂量减半组34例(44%)患者出现不良事件,而剂量稳定组42例(54%),两组均未发生不良事件导致的停药,未发生任何死亡事件。

研究认为,对于接受传统合成改善病情抗风湿药后病情缓解的类风湿性关节炎患者,维持治疗期间药物剂量减少一半后,复发风险增加,不支持剂量减半方案用于RA患者的维持治疗

原始出处

Siri Lillegraven et al. Effect of Half-Dose vs Stable-Dose Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Disease Flares in Patients With Rheumatoid Arthritis in Remission The ARCTIC REWIND Randomized Clinical Trial.JAMA. May 4,2021.

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1765142, encodeId=24d71e65142fb, content=<a href='/topic/show?id=df00e086653' target=_blank style='color:#2F92EE;'>#病情#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70866, encryptionId=df00e086653, topicName=病情)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Tue Aug 17 04:45:38 CST 2021, time=2021-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1905575, encodeId=5dfa19055e5b7, content=<a href='/topic/show?id=0eb34259ea1' target=_blank style='color:#2F92EE;'>#复发风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42597, encryptionId=0eb34259ea1, topicName=复发风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca20190, createdName=wushaoling, createdTime=Sat Feb 05 22:45:38 CST 2022, time=2022-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945105, encodeId=a364194510551, content=<a href='/topic/show?id=19068e690ab' target=_blank style='color:#2F92EE;'>#药物剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87690, encryptionId=19068e690ab, topicName=药物剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Tue Sep 21 13:45:38 CST 2021, time=2021-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1921831, encodeId=18eb192183124, content=<a href='/topic/show?id=4f0a6469837' target=_blank style='color:#2F92EE;'>#治疗药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64698, encryptionId=4f0a6469837, topicName=治疗药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9d3459, createdName=周虎, createdTime=Thu Dec 16 03:45:38 CST 2021, time=2021-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963633, encodeId=6b80963633a6, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9e635479749, createdName=ms2000002016659512, createdTime=Sat May 08 09:38:26 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963505, encodeId=d31096350539, content=学习了,很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210507/57c07aeaae4c44e7a241848bbbd5bbb0/59f529d4459043508900688c698bc460.jpg, createdBy=d2161453363, createdName=zhi7806, createdTime=Fri May 07 21:53:01 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036597, encodeId=fd28103659ed8, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Fri May 07 21:45:38 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963475, encodeId=eebf9634e506, content=赚积分, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5a665251420, createdName=147e0d3fm24暂无昵称, createdTime=Fri May 07 20:23:06 CST 2021, time=2021-05-07, status=1, ipAttribution=)]
    2021-05-08 ms2000002016659512

    学习了

    0

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    2021-05-07 zhi7806

    学习了,很好

    0

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    2021-05-07 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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