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预测炎症性关节炎患者的成功生物降低:基于BIODOPT试验的二次分析
Line Uhrenholt1,2,3, Kirsten Duch1,4, Robin Christensen3,5
1Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
British journal of clinical pharmacology
|June 5, 2023
概括
对于每三名炎症性关节炎患者中,有一人可以实现生物缓解,其目的是减少药物治疗. 分配到逐渐缩减组是成功的唯一显著预测因素,心理健康可能发挥作用.
科学领域:
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
背景情况:
- 生物疗法对于治疗炎症性关节炎至关重要,但长期使用和成本需要探索剂量降低策略.
- 疾病活动引导的生物缓解旨在减少药物负担,同时保持炎症性关节炎患者的疾病控制.
研究的目的:
- 在炎症性关节炎患者中确定成功的生物缩小的预测因素.
- 评估与成功降低生物治疗剂量相关的基线特征.
主要方法:
- 患有类风湿性关节炎,牛皮性关节炎或轴性脊柱关节炎的成人患者在≥12个月的低疾病活性中被随机分配 (2:1) 到疾病活性引导的逐渐减缓或生物治疗的延续.
- 成功的逐渐缩减被定义为≥50%的剂量减少,没有协议偏差,并在18个月后持续低疾病活性.
- 修改Poisson回归被用于分析成功逐渐缩小的预测因素.
主要成果:
- 在142名随机选择的患者中,32%的逐渐减少组成功实现了逐渐减少,而对照组的这一比例为2%.
- 随机分配给逐渐缩减组是成功逐渐缩减的唯一统计学上显著的独立预测因素 (RR:14.0,P=.009).
- 更高的简短形式健康调查36精神组成部分摘要 (SF-36 MCS) 显示了预测成功逐渐缩小的趋势 (RR:1.06,P=.097).
结论:
- 生物逐渐缩减对于相当一部分炎症性关节炎患者来说是一个可行的策略.
- 除了干预本身之外,没有任何基线临床特征是成功逐渐减少的显著预测因素.
- 需要进一步研究心理健康在生物疗法逐渐减少中的作用.
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