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在类风湿性关节炎中治疗反应的异质性使用基于组的轨迹模型:对临床试验数据的二次分析
Fowzia Ibrahim1, Ian C Scott2,3, David L Scott4
1Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, UK. fowzia.ibrahim@kcl.ac.uk.
BMC rheumatology
|September 25, 2023
概括
基于组的轨迹模型确定了三组类风湿性关节炎患者对强化治疗的反应组. 基线肥胖和抑郁预测结果较差,突出了个性化治疗策略的潜力.
科学领域:
- 类风湿病学 类风湿病学
- 临床试验分析
- 生物统计学 生物统计学
背景情况:
- 传统的风湿性关节炎 (RA) 试验使用了响应者/非响应者二元分类,忽视了响应的可变性.
- 基于组的轨迹模型 (GBTM) 通过识别具有明显结果轨迹的患者子组,提供了细微的方法.
- 本研究分析了TITRATE临床试验,以分类RA患者对使用GBTM强化治疗的反应.
研究的目的:
- 应用GBTM来根据患者对强化RA治疗的反应轨迹将患者分为子组.
- 为了确定与RA患者不同治疗应答轨迹相关的基线因素.
主要方法:
- 对TITRATE试验进行了二次分析,该试验涉及163名RA患者,他们在一年内接受了密集治疗.
- 基于组的轨迹模型 (GBTM) 应用于28个关节 (DAS28) 的每月疾病活动评分测量.
- 根据不同的DAS28结果轨迹确定了患者子组.
主要成果:
- GBTM确定了三个患者轨迹:良好 (n=40),中度 (n=76) 和差 (n=47) 的反应.
- 基线肥胖,残疾,疲劳和抑郁水平在各组之间有显著差异.
- 良好的响应者有较低的肥胖和抑郁率,并且与中度和低响应者相比,需要更少的高成本生物药物.
结论:
- 在接受密集治疗的RA患者中,GBTM有效地确定了不同的疾病活动轨迹.
- 像肥胖和抑郁症这样的基线特征可以预测治疗反应.
- 这些发现支持GBTM在RA治疗中开发精准医学方法的潜力.
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