Real-World Safety and Efficacy of Targeted Therapies in Rheumatoid Arthritis: A 5-Year, 5130-Case Follow-Up from FIRST Registry.

IF 2.9 3区医学 Q2 RHEUMATOLOGY

Rheumatology and Therapy Pub Date : 2025-06-01 Epub Date: 2025-04-21 DOI:10.1007/s40744-025-00762-w

Koshiro Sonomoto, Shingo Nakayamada, Hiroaki Tanaka, Atsushi Nagayasu, Yoshiya Tanaka

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Abstract

Introduction: This work aims to illustrate the evolution and ongoing challenges of rheumatoid arthritis (RA) management with targeted therapy over 20 years, using a cohort study from the world's oldest society.

Methods: Data were obtained from FIRST registry, a multicenter cohort of patients with RA treated with biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Patients were followed for 60 months and assessed for drug efficacy, retention, and reasons for discontinuation.

Results: Analysis of 5130 treatments over 16,616 person-years revealed shifts in strategies and demographics. Despite an aging population (51.9-64.3 years) with increasing comorbidities (lung disease: 11.1-36.2%, malignancy: 2.2-13.1%), b/tsDMARD use expanded to include patients with lower disease activity. With better disease control, discontinuations due to adverse events decreased, and particularly infections fell from 2.1 to 0.7 per 100 person-years. Remission rates improved over time in the naïve group but remained largely unchanged in the prior b/tsDMARDs group. Retention rates varied by bDMARD class, with TNF inhibitors (TNFi) showing a decrease over time and IL-6 receptor inhibitors (IL-6Ri) and CTLA4-Ig showing an increase in retention. TNFi had high remission rates but low retention, whereas CTLA4-Ig and IL-6Ri had lower remission rates and higher retention. Changes in functional improvement were modest overall, and in patients aged 75 years and older, functional gains remained limited.

Conclusions: The study highlights the evolving landscape of RA management in an aging society, noting gains in efficacy and safety. However, unmet needs persist, particularly for patients not fully achieving treat-to-target goals and those with limited functional improvement.

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靶向治疗类风湿性关节炎的真实世界安全性和有效性：来自FIRST注册中心的5130例5年随访

本研究旨在通过一项来自世界上最古老的社会的队列研究，说明20年来类风湿关节炎（RA）靶向治疗的演变和持续的挑战。方法：数据来自FIRST注册中心，这是一个多中心队列研究，研究对象是接受生物/靶向合成疾病改善抗风湿药物（b/tsDMARDs）治疗的RA患者。对患者进行为期60个月的随访，并评估药物疗效、保留情况和停药原因。结果：5130种治疗超过16616人年的分析揭示了策略和人口统计学的变化。尽管人口老龄化（51.9-64.3岁），合并症增加（肺部疾病：11.1-36.2%，恶性肿瘤：2.2-13.1%），b/tsDMARD的使用扩大到包括疾病活动性较低的患者。随着疾病控制的改善，不良事件导致的停药减少，特别是感染从每100人年2.1例下降到0.7例。naïve组的缓解率随着时间的推移而提高，但在先前的b/tsDMARDs组中基本保持不变。保留率因bDMARD类别而异，TNF抑制剂（TNFi）随着时间的推移而减少，IL-6受体抑制剂（IL-6Ri）和CTLA4-Ig显示保留率增加。TNFi的缓解率高，保留率低，而CTLA4-Ig和IL-6Ri的缓解率低，保留率高。总的来说，功能改善的变化是适度的，在75岁及以上的患者中，功能改善仍然有限。结论：该研究强调了老龄化社会中RA管理的发展前景，注意到有效性和安全性的提高。然而，未满足的需求仍然存在，特别是那些没有完全实现治疗目标和功能改善有限的患者。

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来源期刊

Rheumatology and Therapy RHEUMATOLOGY-

CiteScore

6.00

自引率

5.30%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Rheumatology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of rheumatologic therapies. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. Areas of focus include, but are not limited to, rheumatoid arthritis, gout, gouty arthritis, psoriatic arthritis, osteoarthritis, juvenile idiopathic/rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis, Pompe’s disease, inflammatory joint conditions, musculoskeletal conditions, systemic sclerosis, and fibromyalgia. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial protocols, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Rheumatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Ethics and Disclosures The journal is a member of the Committee on Publication Ethics (COPE) and subscribes to its principles on how to deal with acts of misconduct thereby committing to investigate allegations of misconduct in order to ensure the integrity of research. Content in this journal is peer-reviewed (Single-blind). 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