编者：韩青，西京医院临床免疫科

目  的

比较持续低疾病活动的RA患者10年的研究结果，初始英夫利昔单抗或激素和SSZ联合或无MTX治疗。

方  法

从Behandel Strategieen (最好的治疗策略)的研究中，对近10年的RA患者随访结果进行了分析，治疗目标严格控制在DAS ⩽ 2.4。被选中的RA患者从6个月到10年都有较低的疾病活动度，因此没有加强治疗。患者被分成接受MTX单一疗法的患者和接受最初联合治疗的患者。用(广义的)线性混合模型分析比较了组间差异，对DAS、HAQ、ESR、视觉模拟量表、患者健康评估、患者(无药物)缓解率的百分比以及夏普/范德赫德评分的患者百分比。

结  果

在10年的观察中，与68/261(26%)联合治疗的患者相比(所有人都逐渐减少到单一疗法或无药物治疗)，MTX单一疗法(一些逐渐减少到无药物治疗)的患者中，有28/247(11%)的患者持续DAS<2.4。随着时间的推移，持续反应者之间无组间差异，MTX单一药物治疗后无药物缓解的患者比例较高。DAS、ESR和视觉模拟量表、患者总体健康评估之间有相互影响，但结果在临床上可忽略不计。

结  论

最初使用强的松或英夫利昔单抗联合治疗的患者比单用MTX单药治疗的患者达到低疾病活动人数多，但未发现额外的受益。无论是否有诱导缓解治疗，持续低疾病活动的患者经长期观察有类似的结果，只有在MTX单一疗法后，有较高比例的患者获得无药物缓解。

参考文献：

Rheumatoid arthritis patients withcontinued low disease activity have similar outcomes over 10 years, regardlessof initial therapy.

BergstraSA,LandewéRBM,HuizingaTWJ,AllaartCF.

ABSTRACT

OBJECTIVES:

To compare 10-year disease outcomes of RA patients who havecontinuous low disease activity and are on MTX with or without initialcombination therapy with infliximab or prednisone and SSZ.

METHODS:

Recent-onset RA patients from the Behandel Strategieen (BeSt)(Dutch acronym for Treatment Strategies) study with 10 years of follow-up wereanalysed. Treatment was tightly controlled, targeted at DAS ⩽ 2.4. Theselected patients had low disease activity from 6 months until 10 years andtherefore did not intensify treatment. Patients were grouped into thosereceiving MTX monotherapy and those receiving initial combination therapy.Between-group differences over time were compared, using (generalized) linearmixed model analyses, for the outcomes DAS, HAQ, ESR, visual analogue scalepatient global health, percentage of patients in (drug-free) remission andpercentage of patients with Sharp/van der Heijde score progression ⩾5.

RESULTS:

At 10 years, 28/247 (11%) patients on MTX monotherapy (sometapered to drug free) had continued DAS ⩽ 2.4 compared with68/261 (26%) patients on combination therapy (all tapered to monotherapy ordrug free). No between-group differences in continuous responders were foundover time, except for a higher percentage of patients in drug-free remissionafter MTX monotherapy. Significant group-time interactions were found for DAS,ESR and visual analogue scale patient global health, but the results seemclinically negligible.

CONCLUSION:

More patients achieved continuous low disease activity on initialprednisone or infliximab combination therapy than on initial MTX monotherapy,but there appeared to be no additional benefits. Regardless of inductiontherapy, patients with continuous low disease activity have similar long-termoutcomes, with only a higher proportion of patients in drug-free remissionafter MTX monotherapy.

Rheumatology(Oxford).2017Oct1;56(10):1721-1728.doi:10.1093/rheumatology/kex236.