在类风湿性关节炎中最初的葡萄糖皮质体桥梁:它是否会随着时间的推移影响葡萄糖皮质体的使用?
Lotte van Ouwerkerk1, Patrick Verschueren2, Maarten Boers3
1Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands.
Annals of the rheumatic diseases
|August 22, 2023
概括
类风湿性关节炎患者的葡萄糖皮质醇桥梁治疗导致症状改善速度更快,药物更改更少. 虽然最初的使用量较高,但长期使用的葡萄糖皮质体 (GC) 和累积剂量在各组之间相似.
科学领域:
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
- 免疫学 免疫学 免疫学
背景情况:
- 风湿性关节炎 (RA) 管理通常涉及葡萄糖皮质类药物 (GCs).
- 最初的GC桥梁治疗在RA治疗中的作用仍然是一个研究领域.
- 了解长期GC使用模式对于优化RA患者的治疗结果至关重要.
研究的目的:
- 为了比较长期使用的葡萄糖皮质类药物 (GCs) 在类风湿性关节炎 (RA) 患者接受初始GC桥梁疗法与那些没有.
- 评估GC桥梁对24个月的疾病活动和药物变化的影响.
主要方法:
- 一个个体患者数据 (IPD) 的元分析结合了来自BeSt,CareRA和COBRA试验的数据.
- 混合效应回归分析比较了GC使用,疾病活性评分 (DAS28) 和疾病修饰性抗风湿药物 (DMARD) 在12个月,18个月和24个月的桥梁和非桥梁组之间的变化.
- 评估了24个月的平均累积GC剂量.
主要成果:
- 40%的患者 (252/625) 接受了GC桥接.
- 桥梁患者在前6个月表现出更快的改善,并且需要更少的DMARD变化 (IRR为0.59).
- 虽然GC使用在12个月的桥梁中更高,但后来GC使用和累积剂量 (不包括桥梁) 类似. 桥梁将2年的累积GC剂量增加了2406毫克.
结论:
- 在RA中,GC桥梁疗法与更快的初始症状缓解和减少对DMARD调整的需求有关.
- 在桥梁和非桥梁组之间,晚期GC使用和整体累积剂量是可比的.
- 正如预期的那样,GC桥接协议会在两年内产生更高的累积GC剂量,但具有明显的临床益处.
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