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使用生物修饰疾病的抗风湿性治疗序列来对类型为副类型的风湿性关节炎进行治疗
Priyam Das1,2, Dana Weisenfeld3, Kumar Dahal3
1Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Arthritis research & therapy
|June 2, 2023
概括
患有类风湿性关节炎 (RA) 的患者可以根据其生物修饰性抗风湿药物 (bDMARD) 治疗史进行分组,揭示出不同的疾病活动模式. 这种bDMARD测序方法为亚现象类型的RA患者提供了一种新的方法,用于更好的治疗反应研究.
科学领域:
- 类风湿病学 类风湿病学
- 计算生物学 计算生物学
- 医疗信息学 医疗信息学
背景情况:
- 类风湿性关节炎 (RA) 往往需要对多种生物修饰性抗风湿药物 (bDMARDs) 进行试验,以有效控制疾病.
- 使用的bDMARDs的序列可能反映了RA患者的潜在亚现型.
- 识别不同的RA亚表型可以改善治疗策略和治疗结果.
研究的目的:
- 根据他们的bDMARD处方史,调查是否会出现不同的RA患者群.
- 确定这些已识别的集群是否与疾病活动的不同轨迹相关.
主要方法:
- 使用了基于电子健康记录 (EHR) 验证的RA队列 (2008-2019).
- 模拟bDMARD/针对性合成DMARD (tsDMARD) 序列作为马尔科夫链来识别患者集群.
- 将EHR数据与临床疾病活动指数 (CDAI) 注册表数据联系起来,以分析疾病轨迹.
主要成果:
- 分析了2172名RA患者,根据bDMARD/tsDMARD序列确定了4个主要集群.
- 集群1:TNFi持久性 (65.7%);集群2:TNFi和阿巴切 (8.0%);集群3:瑞图西马布或多种bDMARDs (12.7%);集群4:托西利祖马布占主导 (13.6%).
- 与其他集群相比,TNFi持久者在一段时间内表现出最有利的CDAI轨迹.
结论:
- 通过他们顺序的bDMARD/tsDMARD处方史,可以有效地对RA患者进行分组.
- 这些群体与疾病活动进展的独特模式相关.
- 这种方法为RA亚表型化提供了一种新的方法,以更好地了解治疗反应.
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