Effect of sustained intensive therapy with disease modifying anti-rheumatic drugs in rheumatoid arthritis: a 5-year real-world consecutive study.
10.1097/CM9.0000000000000811
- Author:
Yue-Ming CAI
1
;
Ru LI
1
;
Hua YE
1
;
Jing HE
1
;
Xiao-Lin SUN
1
;
Jia-Yang JIN
1
;
Jia-Jia LIU
1
;
Yu-Zhou GAN
1
;
Xu-Jie YOU
1
;
Jing XU
2
;
Lian-Jie SHI
2
;
Gong CHENG
1
;
Qing-Wen WANG
3
;
Zhan-Guo LI
1
Author Information
1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China.
2. Department of Rheumatology and Immunology, Peking University International Hospital, Beijing 102206, China.
3. Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518035, China.
- Publication Type:Journal Article
- From:
Chinese Medical Journal
2020;133(12):1397-1403
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Intensive therapy with disease modifying anti-rheumatic drugs (DMARDs) has been reported to improve the outcomes of rheumatoid arthritis (RA). However, real-world study on the effect of intensive therapy on RA sustained remission is still lacking. This study aimed to investigate the outcome of sustained intensive DMARD therapy (SUIT) for RA in a real-world 5-year consecutive cohort.
METHODS:Based on a consecutive cohort of 610 out-patients with RA, remission of RA was assessed in 541 patients from 2012 to 2017, by dividing into SUIT, non-SUIT, and intermittent SUIT (Int-SUIT) groups. Changes in the disease activity scores were evaluated by 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR), 28-joint disease activity score based on C-reactive protein (DAS28-CRP), and clinical deep remission criteria (CliDR). Cumulative remission rates between different groups were compared using Kaplan-Meier curves and predictive factors of sustained remission were identified by univariate and multivariate logistic regression analysis.
RESULTS:The remission rates of the SUIT group decreased from 12.0% (65/541) to 5.6% (20/359) based on DAS28-ESR, from 14.0% (76/541) to 7.2% (26/359) based on DAS28-CRP, and from 8.5% (46/541) to 3.1% (11/359) based on CliDR, respectively, with a gradually decreasing trend during the 5 years. The SUIT regimen led to a significantly higher cumulative remission rate than non-SUIT regimen based on DAS28-ESR (39.7% vs. 19.5%, P = 0.001), DAS28-CRP (42.0% vs. 19.6%, P = 0.001), and CliDR (24.5% vs. 8.7%, P = 0.001). The cumulative remission rates of patients treated with SUIT regimen were significantly higher than those treated with Int-SUIT regimen based on DAS28-ESR (39.7% vs. 25.7%, P = 0.043) and CliDR (24.5% vs. 14.2%, P = 0.047), but there was no significant difference between the two groups based on DAS28-CRP (42.0% vs. 27.4%, P = 0.066). Multivariate logistic regression analysis showed that the use of SUIT regimen was an independent favorable predictor according to different remission definitions (for DAS28-ESR: odds ratio [OR], 2.215, 95% confidence interval [CI]: 1.271-3.861, P = 0.005; for DAS28-CRP: OR, 1.520, 95% CI: 1.345-1.783, P = 0.002; for CliDR: OR, 1.525, 95% CI: 1.314-1.875, P = 0.013).
CONCLUSION:Sustained intensive treatment of RA is an optimal strategy in daily practice and will lead to an increased remission rate.
