Τίτλος:
Rheumatoid arthritis patients on persistent moderate disease activity on biologics have adverse 5-year outcome compared to persistent low-remission status and represent a heterogeneous group
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: The long-term outcome of rheumatoid arthritis (RA) patients who in clinical practice exhibit persistent moderate disease activity (pMDA) despite treatment with biologics has not been adequately studied. Herein, we analyzed the 5-year outcome of the pMDA group and assessed for within-group heterogeneity. Methods: We included longitudinally monitored RA patients from the Hellenic Registry of Biologic Therapies with persistent (cumulative time ≥ 50% of a 5-year period) moderate (pMDA, 3.2 < DAS28 ≤ 5.1) or remission/low (pRLDA, DAS28 ≤ 3.2) disease activity. The former was further classified into persistent lower-moderate (plMDA, DAS28 < 4.2) and higher-moderate (phMDA, DAS28 ≥ 4.2) subgroups. Five-year trajectories of functionality (HAQ) were the primary outcome in comparing pRLDA versus pMDA and assessing heterogeneity within the pMDA subgroups through multivariable mixed-effect regression. We further compared serious adverse events (SAEs) occurrence between the two groups. Results: We identified 295 patients with pMDA and 90 patients with pRLDA, the former group comprising of plMDA (n = 133, 45%) and phMDA (n = 162, 55%). pMDA was associated with worse 5-year functionality trajectory than pRLDA (+ 0.27 HAQ units, CI 95% + 0.22 to + 0.33; p < 0.0001), while the phMDA subgroup had worse 5-year functionality than plMDA (+ 0.26 HAQ units, CI 95% 0.18 to 0.36; p < 0.0001). Importantly, higher persistent disease activity was associated with more SAEs [pRLDA: 0.2 ± 0.48 vs pMDA: 0.5 ± 0.96, p = 0.006; plMDA: 0.32 ± 0.6 vs phMDA: 0.64 ± 1.16, p = 0.038]. Male gender (p = 0.017), lower baseline DAS28 (p < 0.001), HAQ improvement > 0.22 (p = 0.029), and lower average DAS28 during the first trimester since treatment initiation (p = 0.001) independently predicted grouping into pRLDA. Conclusions: In clinical practice, RA patients with pMDA while on bDMARDs have adverse long-term outcomes compared to lower disease activity status, while heterogeneity exists within the pMDA group in terms of 5-year functionality and SAEs. Targeted studies to better characterize pMDA subgroups are needed, in order to assist clinicians in tailoring treatments. © 2020 The Author(s).
Συγγραφείς:
Genitsaridi, I.
Flouri, I.
Plexousakis, D.
Marias, K.
Boki, K.
Skopouli, F.
Drosos, A.
Bertsias, G.
Boumpas, D.
Sidiropoulos, P.
Περιοδικό:
Arthritis Research and Therapy
Εκδότης:
BioMed Central Ltd.
Λέξεις-κλειδιά:
biological product; disease modifying antirheumatic drug; methotrexate; prednisolone; tumor necrosis factor inhibitor, adult; adverse event; adverse outcome; age; Article; cohort analysis; controlled study; DAS28; disease activity; disease classification; female; follow up; functional status; Health Assessment Questionnaire; human; illness trajectory; infection; longitudinal study; major clinical study; male; middle aged; outcome assessment; persistent higher moderate disease activity; persistent lower moderate disease activity; persistent moderate disease activity; prognosis; remission; rheumatoid arthritis; sex difference; treatment duration
DOI:
10.1186/s13075-020-02313-w
