ARD:RA患者初始治疗使用糖皮质激素后停药成功率如何?

2022-07-12 MedSci原创 MedSci原创

在类风湿性关节炎(RA)患者临床试验中,糖皮质激素(GC)停药大多是成功的,尽管 22%的开始GC桥接治疗的患者在12个月时仍然或再次使用GC,在24个月时为10%。

目的:临床试验反复表明,在新诊断的类风湿性关节炎(RA)患者中,在常规合成(cs) DMARD的初始治疗中加入糖皮质激素(GC)比单独使用csDMARD治疗更有效。然而,有人担心长期使用GC会增加与剂量和持续时间相关的严重副作用风险,其中包括心血管疾病、感染和死亡率增加。该系统综述目的在于调查在观察性队列和临床试验中使用临时性GC作为新诊断的RA患者一部分的初始治疗(“桥接”)随访期间GC停药的成功率。

方法进行了系统的文献检索,以确定接受初始GC桥接治疗的RA患者(定义为1年内停止GC治疗)观察性队列和临床试验。仍在使用GC的患者被认为非成功停药。随机效应荟萃分析按时间点分层进行。

结果对观察性队列研究的范围界定文献搜索没有发现可以回答研究问题的研究。对临床试验的文献检索确定了7160篇摘要,结果纳入了10项研究,其中GC的类型和剂量以及逐渐减少的时间表各不相同,其中4项报告了在桥接阶段后停止或使用GC的充分数据。12个月时仍然或再次使用GC的患者汇总比例为22%95% CI 8%~37%,基于四项试验)和24 个月时为10%95%CI -1 ~22,基于两次试验)。异质性很大(I²≥65%)。

结论在有限数量的研究中描述了作为RA初始治疗一部分的桥接后GC终止的成功率。关于观察性队列的报告没有回答研究问题。在临床试验中,GC停药大多是成功的,尽管 22%的开始GC桥接治疗的患者在12个月时仍然或再次使用GC,在24个月时为10%

出处:van Ouwerkerk L, Palmowski A, Nevins IS, et al. Systematic literature review of observational cohorts and clinical trials into the success rate of glucocorticoid discontinuation after their use as bridging therapy in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 2022;81:937-943.

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    2022-07-13 yinhl1980
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