降低期望:在风湿性关节炎的退伍军人中降低葡萄糖皮质体缩,在稳定的生物疗法下实现低疾病活动
Beth I Wallace1, Bryant R England2, Joshua F Baker3
1Center for Clinical Management Research, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor.
ACR open rheumatology
|July 26, 2023
概括
大约一半的类风湿性关节炎患者在疾病活性较低的情况下,在开始使用新的生物或向合成疾病修饰性抗风湿药物 (b/tsDMARD) 后的六个月内成功地减轻了葡萄糖皮质类药物. 三分之一的人完全停止服用普雷尼松.
科学领域:
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
- 现实世界的证据 现实世界的证据
背景情况:
- 葡萄糖皮质激素的逐渐减少是风湿性关节炎 (RA) 管理的一个关键目标.
- 类固醇消除在类风湿性关节炎 (SEMIRA) 试验显示,在逐渐减少的成功率为65%.
- 需要现实世界的数据来证实这些发现在类似的患者群体.
研究的目的:
- 评估RA患者在稳定的生物治疗中实现低疾病活性 (LDA) 的真实世界葡萄糖皮质体逐渐减少率.
- 将结果与SEMIRA试验结果进行比较.
- 在大量患者队列中确定成功逐渐缩小的预测因素.
主要方法:
- 未来的RA队列使用注册和药房索赔数据 (2003-2021年).
- 在b/tsDMARD启动后,已识别的慢性普得尼松使用者实现了LDA.
- 定义成功的逐渐缩减为普得尼松剂量≤5mg/天,在LDA后180天减少≥50%.
主要成果:
- 在95名患者中评估了100个b/tsDMARD疗程.
- 在54%的疗程中,成功的逐渐减少发生;在33%的疗程中,中止发生.
- 与成功的逐渐缩减相关的因素包括积极的类风湿因子,更高的ESR,更多的背景DMARD,更短的LDA时间和更高的前期葡萄糖皮质激素剂量.
结论:
- 在LDA中,大约一半的RA患者在开始新b/tsDMARD后的6个月内成功地逐渐减少了葡萄糖皮质类药物.
- 三分之一的患者完全停止服用普雷尼松.
- 基于索赔的算法可以有效地评估行政数据中的糖皮质激素逐渐减少和停止.
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