Ann Rheum Dis:类风湿性关节炎患者激素联合csDMARD 治疗后激素的减量轨迹

2021-08-11 xiangting MedSci原创

对于开始 GC联合csDMARDs 治疗的 RA 患者,可以停用GC,并且疾病活动性控制良好,大多数患者短期内无发作。

很多类风湿性关节炎 (RA) 患者单独使用糖皮质激素 (GC)治疗效果不佳,需要联合其他抗风湿药物治疗。近日发表在风湿病学顶尖杂志Ann Rheum Dis上的一篇文章阐述了RA患者在开始 GC和常规合成疾病改善抗风湿药物 (csDMARDs)联合治疗后,GC减量和停药的动态轨迹及特征。

                                                 

 

研究使用了来自 RA 队列的真实靶向治疗数据。纳入开始 GC 和csDMARDs 联合治疗的 RA 患者。评估了 GC 剂量和疾病活动性的变化。使用 Kaplan-Meier 分析了GC 停药率。还分析了GC 停药后 6 个月内的复发情况。

 

结果如下:共纳入 207 例 RA 患者。在 38.6 个月的中位随访期间,124 例患者停用 GC。开始时泼尼松龙的中位剂量为 10 (5-10)mg/天,前 6 个月内剂量减少了 50%,然后减量速度变慢,最终在第 48 个月时减至0。第 6 个月,第 1、2 和 3 年GC 停药的累积概率分别为 9.7%、26.6%、48.0% 和 58.6%, GC 停药的中位时间为 27 个月。在 110 例 DMARD 初治患者中,GC 停药的相应累积概率分别为 12.7%、30.0%、50.9% 和 60.6%, GC 停药的中位时间为 24 个月。在停用 GC 的 124 例患者中,28.2% 的患者加用了其他 csDMARDs 或 csDMARDs 加量。124 例患者中约有一半在 GC 停药时处于临床缓解状态。GC 停药后 6 个月内,79.1% 的患者(91/115) 保持无复发。

                                     图:激素停药累积概率的Kaplan-Meier分析曲线

由此可见,对于开始 GC联合csDMARDs 治疗的 RA 患者,可以停用GC,并且疾病活动性控制良好,大多数患者短期内无发作。但停药时间远未达到推荐的时间范围,这表明真实临床实践与现行指南之间存在差距。

 

原始出处:

Wenhui Xie. Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020 . Ann Rheum Dis. August  2021.

 

 

 

 

 

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    2021-09-09 lq1767
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    2021-08-13 lmm397
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    2021-08-13 whlxd
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    2021-08-11 ms4000000408264698

    good

    0

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