Long-term clinical outcomes in early rheumatoid arthritis that was treated-to-target in the BeSt and IMPROVED studies.

IF 4.7 2区医学 Q1 RHEUMATOLOGY

Rheumatology Pub Date : 2025-03-01 DOI:10.1093/rheumatology/keae212

Sascha Louise Heckert, Johanna M Maassen, Isabell Nevins, Paul Baudoin, Gerda M Steup-Beekman, Tom W J Huizinga, Sytske Anne Bergstra, Cornelia F Allaart

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引用次数: 0

Abstract

Objectives: To assess disease outcomes after 20 and 12 years of patients with RA or undifferentiated arthritis (UA), treated-to-target in the BeSt and IMPROVED trials.

Methods: In BeSt (inclusion 2000-02, duration 10 years), 508 patients with early RA were randomized to: 1. sequential monotherapy, 2. step-up combination therapy, 3. initial csDMARD combination therapy, 4. initial bDMARD/csDMARD combination therapy. The treatment target was low disease activity (DAS ≤ 2.4).In IMPROVED (inclusion 2007-10, duration 5 years), 610 patients with early RA/UA started MTX with prednisone bridging. The treatment target was remission (DAS < 1.6). Patients not in early remission were randomized to 1. csDMARD combination therapy or 2. bDMARD/csDMARD combination therapy.Between 2019 and 22, these patients were invited for long-term follow-up.

Results: One-hundred-fifty-three ex-Best and 282 ex-IMPROVED patients participated in the follow-up study after a median of 12 and 20 years since the study started.In ex-BeSt and ex-IMPROVED patients, the rate of low disease activity was 91%, and 68% were in DAS remission. Median SHS was 14.0 in ex-BeSt (IQR 6.0-32.5; progression since end BeSt 6.0, IQR 2.0-12.5) and 8 in ex-IMPROVED participants (IQR 3-16; progression since end IMPROVED 4, IQR 2-9). Mean HAQ was 0.8 ± 0.6 in ex-BeSt (change since end BeSt: 0.3 ± 0.5) and 0.6 ± 0.6 in ex-IMPROVED participants (change since end IMPROVED: 0.06 ± 0.5).

Conclusion: At 12/20 years after treatment started, the majority of RA and UA patients who had been treated to target low DAS or DAS remission were in DAS remission and had limited functional disability. Radiographic damage progression was mild although not completely suppressed.

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在 BeSt 和 IMPROVED 研究中接受靶向治疗的早期类风湿关节炎患者的长期临床疗效。

目标：评估类风湿（RA）或未分化关节炎（UA）患者在BeSt和IMPROVED试验中接受目标治疗20年和12年后的疾病预后：在 BeSt 试验（2000-2002 年纳入，持续时间 10 年）中，508 名早期类风湿关节炎患者被随机分配接受以下治疗：1：1.序贯单药治疗；2.阶梯式联合治疗；3.初始 csDMARD 联合治疗；4.初始 bDMARD/csDMARD 联合治疗。在IMPROVED（纳入时间为2007-2010年，持续时间为5年）中，610名早期RA/UA患者开始接受MTX与泼尼松桥接治疗。治疗目标是缓解（DAS结果）：自研究开始以来，分别有 153 名和 282 名前 IMPROVED 患者在中位 12 年和 20 年后参加了随访研究。前BeSt患者的SHS中位数为14.0（IQR为6.0-32.5；自BeSt结束后病情进展为6.0，IQR为2.0-12.5），前IMPROVED参与者的SHS中位数为8（IQR为3-16；自IMPROVED结束后病情进展为4，IQR为2-9）。前BeSt参与者的平均HAQ为0.8 ± 0.6（自BeSt结束后的变化：0.3 ± 0.5），前IMPROVED参与者的平均HAQ为0.6 ± 0.6（自IMPROVED结束后的变化：0.06 ± 0.5）：结论：在治疗开始 12/20 年后，大多数接受过以低 DAS 或 DAS 缓解为目标的治疗的 RA 和 UA 患者仍处于 DAS 缓解状态，功能残疾程度有限。放射学损伤进展虽然没有完全被抑制，但很轻微。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.