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Factors associated with discontinuation of glucocorticoids after starting biological disease-modifying antirheumatic drugs in rheumatoid arthritis patients.

类风湿性关节炎患者开始使用生物疾病修饰抗风湿药后停用糖皮质激素的相关因素。

  • 影响因子:1.72
  • DOI:10.1080/14397595.2018.1553264
  • 作者列表:"Inoue M","Kanda H","Tateishi S","Fujio K
  • 发表时间:2020-01-01
Abstract

:Objectives: Glucocorticoids (GCs) are effective treatments for rheumatoid arthritis (RA) but long-term use has adverse effects. This study aimed to elucidate whether GCs can be discontinued by introducing biological disease-modifying antirheumatic drugs (bDMARDs) and the factors influencing the outcome.Method: We included RA patients who had been orally taking GCs at the initiation of bDMARDs. The changes in GC dose after starting bDMARDs were evaluated and the GC discontinuation rate was analyzed using Kaplan-Meier analysis. The factors associated with discontinuation of GCs were assessed by Cox hazard models.Results: Eighty RA patients were included in the study. The dosage of oral prednisolone (PSL) was significantly reduced from 5.0 to 3.0 mg/day by 3 months (p = .013). GCs were discontinued in 31.3% of patients and the median time until GC discontinuation was 10.1 months. The GC discontinuation rate was significantly higher in patients with Class 1 and 2 (p = .024), with an initial PSL dose <5 mg/day (p = .040), and with low DAS28(ESR) (p = .038). In multivariate analyses, higher DAS28(ESR) (odds ratio, 0.200; p = .039), and higher PSL dose (odds ratio, 0.748; p = .029) were significantly associated with less frequent GC discontinuation.Conclusion: DAS28(ESR) high and PSL dose were factors associated with discontinuation of GC use after starting bDMARDs.

摘要

目的: 糖皮质激素 (GCs) 是治疗类风湿关节炎 (RA) 的有效药物,但长期使用有副作用。本研究旨在阐明是否可以通过引入生物修饰疾病抗风湿药 (bDMARDs) 来停用GCs以及影响预后的因素。方法: 我们纳入了在bDMARDs开始时口服GCs的RA患者。评估启动bDMARDs后GC剂量的变化,并使用Kaplan-Meier分析GC停药率。通过Cox风险模型评估与GCs停药相关的因素。结果: 80 例RA患者纳入研究。口服泼尼松龙 (PSL) 剂量由 5.0 mg/天明显减少 3 个月 (p =.01 3)。31.3% 的患者停用GCs,至GC停用的中位时间为 10.1 个月。1 级和 2 级患者的GC停药率显著较高 (p =  。0 2 4),初始PSL剂量 <5 mg/天 (p =.040),低DAS 2 8(ESR) (p =.038)。在多变量分析中,DAS28(ESR) 较高 (比值比,0.200; P =.039),PSL剂量较高 (比值比,0.748; P =.029) 与较不频繁的GC停药显著相关。结论: DAS28(ESR) 高和PSL剂量是启动bDMARDs后停用GC的相关因素。

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发表时间:2020-01-01
DOI:10.1002/acr.23821
作者列表:["Beltai A","Barnetche T","Daien C","Lukas C","Gaujoux-Viala C","Combe B","Morel J"]

METHODS:OBJECTIVE:Patients with immune-mediated inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus are at increased risk of cardiovascular disease. However, the cardiovascular risk of patients with primary Sjögren's syndrome (SS) remains poorly studied. We aimed to investigate the association between primary SS and cardiovascular morbidity and mortality. METHODS:We performed a systematic review of articles in Medline and the Cochrane Library and recent abstracts from US and European meetings, searching for reports of randomized controlled studies of cardiovascular morbidity and cardiovascular mortality in primary SS. The relative risk (RR) values for cardiovascular morbidity and mortality associated with primary SS were collected and pooled in a meta-analysis with a random-effects model by using Review Manager (Cochrane collaboration). RESULTS:The literature search revealed 484 articles and abstracts of interest; 14 studies (67,124 patients with primary SS) were included in the meta-analysis. With primary SS versus control populations, the risk was significantly increased for coronary morbidity (RR 1.34 [95% confidence interval (95% CI) 1.06-1.38]; P = 0.01), cerebrovascular morbidity (RR 1.46 [95% CI 1.43-1.49]; P < 0.00001), heart failure rate (odds ratio 2.54 [95% CI 1.30-4.97]; P < 0.007), and thromboembolic morbidity (RR 1.78 [95% CI 1.41-2.25]; P < 0.00001), with no statistically significant increased risk of cardiovascular mortality (RR 1.48 [95% CI 0.77-2.85]; P = 0.24). CONCLUSION:This meta-analysis demonstrates that primary SS is associated with increased cardiovascular morbidity, which suggests that these patients should be screened for cardiovascular comorbidities and considered for preventive interventions, in a multidisciplinary approach with cardiologists.

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影响因子:4.13
发表时间:2020-01-01
DOI:10.1002/acr.23824
作者列表:["Chen SK","Liao KP","Liu J","Kim SC"]

METHODS:OBJECTIVE:We aimed to evaluate the comparative risk of hospitalized infection among patients with rheumatoid arthritis (RA) who initiated abatacept versus a tumor necrosis factor inhibitor (TNFi). METHODS:Using claims data from Truven MarketScan database (2006-2015), we identified patients with RA ages ≥18 years with ≥2 RA diagnoses who initiated treatment with abatacept or a TNFi. The primary outcome was a composite end point of any hospitalized infection. Secondary outcomes included bacterial infection, herpes zoster, and infections affecting different organ systems. We performed 1:1 propensity score (PS) matching between the groups in order to control for baseline confounders. We estimated incidence rates (IRs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) for hospitalized infection. RESULTS:We identified 11,248 PS-matched pairs of patients who initiated treatment with abatacept and TNFi with a median age of 56 years (83% were women). The IR per 1,000 person-years for any hospitalized infection was 37 among patients who initiated treatment with abatacept and 47 in those who initiated treatment with TNFi. The HR for the risk of any hospitalized infection associated with abatacept versus TNFi was 0.78 (95% CI 0.64-0.95) and remained lower when compared to infliximab (HR 0.63 [95% CI 0.47-0.85]), while no significant difference was seen when compared to adalimumab and etanercept. The risk of secondary outcomes was lower for abatacept for pulmonary infections, and similar to TNFi for the remaining outcomes. CONCLUSION:In this large cohort of patients with RA who initiated treatment with abatacept or TNFi as a first- or second-line biologic agent, we found a lower risk of hospitalized infection after initiating abatacept versus TNFi, which was driven mostly by infliximab.

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影响因子:4.13
发表时间:2020-01-01
DOI:10.1002/acr.23827
作者列表:["Lee RR","Rashid A","Thomson W","Cordingley L"]

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关节疾病方向

各类骨关节疾病,包括退行性关节炎、滑囊炎、滑膜炎、颈椎病、腰椎病、肩周炎、骨质增生、风湿性关节炎、类风湿性关节炎、股骨头坏死等。

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