Abstract：
This study had two aims: (i) to investigate outcomes of medication tapering in stable RA patients on biologic or targeted synthetic disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) and conventional synthetic DMARDs (csDMARDs) in a real-world prospective cohort; and (ii) to evaluate possible predictors of flare with medication taper.
A prospective cohort of patients with RA in sustained remission or low disease activity while on stable bDMARD/tsDMARDs +/- csDMARDs for at least 6 months underwent medication tapering/stopping and was tracked for 2 years. Patients were evaluated for flares in four groups: no taper, only bDMARD/tsDMARD taper, only csDMARD taper and both csDMARD and bDMARD/tsDMARD taper.
The RHEUMTAP cohort included 131 patients that met eligibility criteria, of which 52 patients underwent a medication taper. Flare was experienced by 15 patients in the taper and two in the no-taper groups. Patients undergoing any taper/stop overall were 10 times more likely to experience a flare compared with those not tapered (HR 10.43, 95% CI 2.98-36.53, P = 0.0002). The group tapering bDMARD/tsDMARD had 31 times higher risk of flare (HR 31.43, 95% CI 6.35-155.55, P <0.0001) than the no-taper group. Patients tapering both csDMARDs and bDMARD/tsDMARDs had 18 times higher risk of flare than the no-taper group (HR 18.45, 95% CI 2.55-133.37, P = 0.0039). The only csDMARD taper group had a 91% lower risk of flare than the bDMARD/tsDMARD taper group (HR 0.09, 95% CI 0.01-0.69, P = 0.0213).
In our real-world prospective RHEUMTAP cohort study on the outcomes of different medication tapering groups in well-controlled RA, patients who tapered or stopped bDMARDs/tsDMARDs with or without background therapy were more likely to experience a flare than patients that did not taper any medications and those that tapered only csDMARDs.
A prospective cohort of patients with RA in sustained remission or low disease activity while on stable bDMARD/tsDMARDs +/- csDMARDs for at least 6 months underwent medication tapering/stopping and was tracked for 2 years. Patients were evaluated for flares in four groups: no taper, only bDMARD/tsDMARD taper, only csDMARD taper and both csDMARD and bDMARD/tsDMARD taper.
The RHEUMTAP cohort included 131 patients that met eligibility criteria, of which 52 patients underwent a medication taper. Flare was experienced by 15 patients in the taper and two in the no-taper groups. Patients undergoing any taper/stop overall were 10 times more likely to experience a flare compared with those not tapered (HR 10.43, 95% CI 2.98-36.53, P = 0.0002). The group tapering bDMARD/tsDMARD had 31 times higher risk of flare (HR 31.43, 95% CI 6.35-155.55, P <0.0001) than the no-taper group. Patients tapering both csDMARDs and bDMARD/tsDMARDs had 18 times higher risk of flare than the no-taper group (HR 18.45, 95% CI 2.55-133.37, P = 0.0039). The only csDMARD taper group had a 91% lower risk of flare than the bDMARD/tsDMARD taper group (HR 0.09, 95% CI 0.01-0.69, P = 0.0213).
In our real-world prospective RHEUMTAP cohort study on the outcomes of different medication tapering groups in well-controlled RA, patients who tapered or stopped bDMARDs/tsDMARDs with or without background therapy were more likely to experience a flare than patients that did not taper any medications and those that tapered only csDMARDs.
摘要：
目的：该研究有两个目的：（i）在真实世界的前瞻性队列中，研究稳定的RA患者使用生物或靶向合成疾病改善抗风湿药（bDMARDs/tsDMARDs）和常规合成DMARDs（csDMARDs）的药物逐渐减少的结果；（ii）评估药物逐渐减少的可能预测因素。
方法：在持续缓解或低疾病活动度的RA患者中，使用稳定的bDMARD/tsDMARDs+/-csDMARDs治疗至少6个月，接受药物逐渐减少/停止治疗，并追踪2年。对四组患者的耀斑进行了评估：无锥度，只有bDMARD/tsDMARD锥度，只有csDMARD锥度和csDMARD和bDMARD/tsDMARD锥度。
结果：RHEUMTAP队列包括131名符合资格标准的患者，其中52名患者接受了药物减量。锥形组中有15例患者经历了耀斑，无锥形组中有2例患者经历了耀斑。与未逐渐缩小的患者相比，接受任何逐渐缩小/停止的患者发生耀斑的可能性要高10倍（HR10.43，95％CI2.98-36.53，P=0.0002）。逐渐变细的bDMARD/tsDMARD组的爆发风险（HR31.43，95％CI6.35-155.55，P<0.0001）比未变细的组高31倍。CSDMARDs和bDMARD/tsDMARDs逐渐减少的患者比未逐渐减少的患者发生耀斑的风险高18倍（HR18.45，95％CI2.55-133.37，P=0.0039）。唯一的csDMARD锥度组比bDMARD/tsDMARD锥度组低91％（HR0.09，95％CI0.01-0.69，P=0.0213）。
结论：在我们的真实世界前瞻性RHEUMTAP队列研究中，在控制良好的RA中，不同药物减量组的结果，使用或不使用背景治疗逐渐减量或停止bDMARDs/tsDMARDs的患者比不使用任何药物逐渐减量和仅使用csDMARDs逐渐减量的患者更有可能出现耀斑.
方法：在持续缓解或低疾病活动度的RA患者中，使用稳定的bDMARD/tsDMARDs+/-csDMARDs治疗至少6个月，接受药物逐渐减少/停止治疗，并追踪2年。对四组患者的耀斑进行了评估：无锥度，只有bDMARD/tsDMARD锥度，只有csDMARD锥度和csDMARD和bDMARD/tsDMARD锥度。
结果：RHEUMTAP队列包括131名符合资格标准的患者，其中52名患者接受了药物减量。锥形组中有15例患者经历了耀斑，无锥形组中有2例患者经历了耀斑。与未逐渐缩小的患者相比，接受任何逐渐缩小/停止的患者发生耀斑的可能性要高10倍（HR10.43，95％CI2.98-36.53，P=0.0002）。逐渐变细的bDMARD/tsDMARD组的爆发风险（HR31.43，95％CI6.35-155.55，P<0.0001）比未变细的组高31倍。CSDMARDs和bDMARD/tsDMARDs逐渐减少的患者比未逐渐减少的患者发生耀斑的风险高18倍（HR18.45，95％CI2.55-133.37，P=0.0039）。唯一的csDMARD锥度组比bDMARD/tsDMARD锥度组低91％（HR0.09，95％CI0.01-0.69，P=0.0213）。
结论：在我们的真实世界前瞻性RHEUMTAP队列研究中，在控制良好的RA中，不同药物减量组的结果，使用或不使用背景治疗逐渐减量或停止bDMARDs/tsDMARDs的患者比不使用任何药物逐渐减量和仅使用csDMARDs逐渐减量的患者更有可能出现耀斑.
