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A combination model to predict relapse and successful conventional DMARDs de-escalation in rheumatoid arthritis patients with sustained clinical remission
L. Wang1, Y. Geng2, J. Han3, X. Sun4, Z. Zhang5
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
- Department of Geriatrics, Peking University First Hospital, Beijing, China.
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China. zhuoli.zhang@126.com
CER10913
2019 Vol.37, N°1
PI 0120, PF 0126
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PMID: 30148433 [PubMed]
Received: 23/10/2017
Accepted : 24/04/2018
In Press: 18/07/2018
Published: 18/01/2019
Abstract
OBJECTIVES:
To determine the long-term outcomes of RA patients in sustained clinical remission under different therapeutic strategies and explore the risk factors to relapse.
METHODS:
RA patients in sustained clinical remission (DAS28(CRP) ≤2.6 for at least 6 months) were enrolled. Their baseline clinical features, ultrasonography and x-ray of hands were collected. The usage of conventional synthetic disease-modified anti-rheumatic drugs (csDMARDs) at baseline and every follow-up visits were recorded. Patients were divided into maintain-therapy group or de-escalate-therapy group according to their treatment during follow-up. The time-point of follow-up visits reaching 2 years or flare (DAS28(CRP)>2.6) was defined as the endpoint of the study. The risk factors to predict flare was analysed by logistic regression model.
RESULTS:
94 patients were enrolled in the study, with 59 in de-escalate-therapy group and 35 in maintain-therapy group. During an average of 20.8 months of follow-up, 40 (42.6%) patients relapsed, with 31 (52.5%) from de-escalate-therapy group and 9 (25.7%) from maintain-therapy group. De-escalate-therapy increased the risk of flare by 2.3 times (OR=3.38, p=0.044). Baseline DAS28(CRP) (OR=6.97, p=0.038), presence of subclinical synovitis (OR=3.67, p=0.024), combination of 2 csDMARDs (OR=3.72, p=0.030) were the risk factors for relapse, and the best cut-off value of DAS28(CRP) for relapse prediction through ROC curve was 1.82. Taking the three parameters into the model for a combined prediction probability, the area under the ROC curve was 0.722 (95% CI 0.61, 0.82, p=0.000).
CONCLUSIONS:
De-escalation therapy was associated with higher risk of relapse in RA patients with sustained clinical remission. A combination model of DAS28(CRP)<1.82 and no subclinical synovitis may help to predict successful csDMARDs reduction in RA patients with sustained clinical remission receiving csDMARDs monotherapy.