PDF(Pubmed)
Abstract：
UNASSIGNED: To identify differences in effectiveness and safety of a treat-to-target (T2T) strategy comparing late-onset MTX-naïve RA patients (LORA) ≥75 or <75 years of age.
UNASSIGNED: Treatment was adjusted to target low disease activity with conventional synthetic DMARDs followed by biologic DMARDs (bDMARDs) in LORA ≥75 years (n = 98, mean age 80.0 years) and LORA <75 years (n = 99) with moderate-high disease activity. Achievement of Simplified Disease Activity Index (SDAI) remission at week 156 by non-responder imputation analysis was evaluated as a primary outcome.
UNASSIGNED: LORA ≥75 years had more comorbidities than LORA <75 years, but SDAI and ACPA positivity were similar at baseline. Of the LORA ≥75 years, 70.4% started MTX and 34.1% and 37.1% received a bDMARD at week 52 and 156, respectively (very similar to the LORA <75 years). Glucocorticoid use was more frequent in the LORA ≥75 years than in the LORA <75 years. Comorbidities/adverse events more frequently contributed to the reasons for non-adherence to T2T in the LORA ≥75 than in the LORA <75. At week 156, 32.7% of the LORA ≥75 and 66.7% of the LORA <75 achieved SDAI remission (P < 0.001). The cumulative incidence of serious adverse events (SAEs) over 156 weeks was 42.8% in the LORA ≥75 and 22.1% in the LORA <75. Multivariable analysis indicated an increased risk of SDAI non-remission at week 156 in the LORA ≥75 [odds ratio 2.82 (95% CI 1.29. 6.14)] after adjusting for comorbidities at baseline, non-adherence to T2T and SAEs.
UNASSIGNED: It was more difficult to achieve remission in the LORA ≥75 patients than in the LORA <75 patients due to both poor treatment response and safety issues.
UNASSIGNED: Treatment was adjusted to target low disease activity with conventional synthetic DMARDs followed by biologic DMARDs (bDMARDs) in LORA ≥75 years (n = 98, mean age 80.0 years) and LORA <75 years (n = 99) with moderate-high disease activity. Achievement of Simplified Disease Activity Index (SDAI) remission at week 156 by non-responder imputation analysis was evaluated as a primary outcome.
UNASSIGNED: LORA ≥75 years had more comorbidities than LORA <75 years, but SDAI and ACPA positivity were similar at baseline. Of the LORA ≥75 years, 70.4% started MTX and 34.1% and 37.1% received a bDMARD at week 52 and 156, respectively (very similar to the LORA <75 years). Glucocorticoid use was more frequent in the LORA ≥75 years than in the LORA <75 years. Comorbidities/adverse events more frequently contributed to the reasons for non-adherence to T2T in the LORA ≥75 than in the LORA <75. At week 156, 32.7% of the LORA ≥75 and 66.7% of the LORA <75 achieved SDAI remission (P < 0.001). The cumulative incidence of serious adverse events (SAEs) over 156 weeks was 42.8% in the LORA ≥75 and 22.1% in the LORA <75. Multivariable analysis indicated an increased risk of SDAI non-remission at week 156 in the LORA ≥75 [odds ratio 2.82 (95% CI 1.29. 6.14)] after adjusting for comorbidities at baseline, non-adherence to T2T and SAEs.
UNASSIGNED: It was more difficult to achieve remission in the LORA ≥75 patients than in the LORA <75 patients due to both poor treatment response and safety issues.
摘要：
■确定治疗对目标（T2T）策略的有效性和安全性差异，比较晚发性MTX初治RA患者（LORA）≥75或<75岁。
■调整治疗目标为低疾病活动度，采用常规合成DMARDs，然后在LORA≥75岁（n=98，平均年龄80.0岁）和LORA<75岁（n=99）中高疾病活动度的生物DMARDs（bDMARDs）。通过无反应者归因分析在第156周实现的简化疾病活动指数（SDAI）缓解被评估为主要结果。
■LORA≥75岁的合并症比LORA<75岁的合并症多，但基线时SDAI和ACPA阳性相似.LORA≥75岁，70.4%开始MTX，34.1%和37.1%分别在第52周和第156周接受bDMARD（与LORA<75年非常相似）。糖皮质激素的使用在LORA≥75岁时比LORA<75岁时更频繁。与LORA<75的患者相比，合并症/不良事件更频繁地导致不遵守T2T的原因。在第156周，32.7%的LORA≥75和66.7%的LORA<75达到SDAI缓解（P<0.001）。在156周内严重不良事件（SAE）的累积发生率在LORA≥75时为42.8％，在LORA<75时为22.1％。多变量分析表明，LORA≥75患者在第156周SDAI未缓解的风险增加[比值比2.82（95％CI1.29。6.14)]调整基线合并症后，不遵守T2T和SAE。
■由于治疗反应差和安全性问题，LORA≥75患者比LORA<75患者更难实现缓解。
■调整治疗目标为低疾病活动度，采用常规合成DMARDs，然后在LORA≥75岁（n=98，平均年龄80.0岁）和LORA<75岁（n=99）中高疾病活动度的生物DMARDs（bDMARDs）。通过无反应者归因分析在第156周实现的简化疾病活动指数（SDAI）缓解被评估为主要结果。
■LORA≥75岁的合并症比LORA<75岁的合并症多，但基线时SDAI和ACPA阳性相似.LORA≥75岁，70.4%开始MTX，34.1%和37.1%分别在第52周和第156周接受bDMARD（与LORA<75年非常相似）。糖皮质激素的使用在LORA≥75岁时比LORA<75岁时更频繁。与LORA<75的患者相比，合并症/不良事件更频繁地导致不遵守T2T的原因。在第156周，32.7%的LORA≥75和66.7%的LORA<75达到SDAI缓解（P<0.001）。在156周内严重不良事件（SAE）的累积发生率在LORA≥75时为42.8％，在LORA<75时为22.1％。多变量分析表明，LORA≥75患者在第156周SDAI未缓解的风险增加[比值比2.82（95％CI1.29。6.14)]调整基线合并症后，不遵守T2T和SAE。
■由于治疗反应差和安全性问题，LORA≥75患者比LORA<75患者更难实现缓解。
