Ana Martins , Sofia Pimenta , Daniela Oliveira , Rafaela Nicolau , Alexandra Bernardo , Teresa Martins Rocha , Lúcia Costa , Miguel Bernardes
{"title":"我们能否预测类风湿关节炎患者在使用 bDMARD 治疗的第一年因疗效不佳而转药的风险因素？","authors":"Ana Martins , Sofia Pimenta , Daniela Oliveira , Rafaela Nicolau , Alexandra Bernardo , Teresa Martins Rocha , Lúcia Costa , Miguel Bernardes","doi":"10.1016/j.reumae.2024.07.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Biological disease-modifying antirheumatic drugs (bDMARD) have improved the clinical course and quality of life of patients with rheumatoid arthritis (RA). However, some patients failed to respond or have an insufficient response to bDMARD early in the course of the treatment.</p></div><div><h3>Objectives</h3><p>To determine the percentage of RA patients who need to switch due to ineffectiveness in the first year of treatment and to identify specific baseline features as possible predictors of switch due to ineffectiveness in the first year of treatment.</p></div><div><h3>Materials and methods</h3><p>An observational retrospective study was conducted with patients with RA that started their first bDMARD. Demographic data, disease characteristics, disease activity data scores, laboratory parameters and treatment at baseline were collected. The proportion of patients who failed to respond and who switched to another bDMARD in the first year of treatment was calculated.</p></div><div><h3>Results</h3><p>A total of 437 (364 females, 83.3%) patients with RA were included. The majority of these patients started an anti-TNF-α agent (<em>n</em> <!-->=<!--> <!-->315, 72.1%). Forty-eight (11.0%) patients failed to respond to the bDMARD in the first year of treatment. There were significantly more current or former smokers (<em>p</em> <!-->=<!--> <!-->0.030), with a history of depression (<em>p</em> <!-->=<!--> <!-->0.003) and positive for RF at baseline (<em>p</em> <!-->=<!--> <!-->0.014) in the switch group.</p><p>In the multivariate analysis, anti-TNF-α agents use (OR 8.3, 95% CI 2.4–28.8, <em>p</em> <!-->=<!--> <!-->0.001), tobacco exposure (OR 2.3, 95% CI 1.1–4.8, <em>p</em> <!-->=<!--> <!-->0.02) and history of depression (OR 3.1, 95% CI 1.3–7.7) seem to predict the need to switch in the first year of treatment due to ineffectiveness.</p></div><div><h3>Discussion and conclusion</h3><p>In our study, tobacco exposure and depression appear to be modifiable risk factors associated with early switching due to ineffectiveness. Addressing these factors in daily clinical practice is crucial to enhance the overall response to therapy and improve the well-being of patients.</p></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Can we predict the risk factors for switching due to ineffectiveness in the first year of therapy with bDMARD in patients with rheumatoid arthritis?\",\"authors\":\"Ana Martins , Sofia Pimenta , Daniela Oliveira , Rafaela Nicolau , Alexandra Bernardo , Teresa Martins Rocha , Lúcia Costa , Miguel Bernardes\",\"doi\":\"10.1016/j.reumae.2024.07.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Biological disease-modifying antirheumatic drugs (bDMARD) have improved the clinical course and quality of life of patients with rheumatoid arthritis (RA). However, some patients failed to respond or have an insufficient response to bDMARD early in the course of the treatment.</p></div><div><h3>Objectives</h3><p>To determine the percentage of RA patients who need to switch due to ineffectiveness in the first year of treatment and to identify specific baseline features as possible predictors of switch due to ineffectiveness in the first year of treatment.</p></div><div><h3>Materials and methods</h3><p>An observational retrospective study was conducted with patients with RA that started their first bDMARD. Demographic data, disease characteristics, disease activity data scores, laboratory parameters and treatment at baseline were collected. The proportion of patients who failed to respond and who switched to another bDMARD in the first year of treatment was calculated.</p></div><div><h3>Results</h3><p>A total of 437 (364 females, 83.3%) patients with RA were included. The majority of these patients started an anti-TNF-α agent (<em>n</em> <!-->=<!--> <!-->315, 72.1%). Forty-eight (11.0%) patients failed to respond to the bDMARD in the first year of treatment. There were significantly more current or former smokers (<em>p</em> <!-->=<!--> <!-->0.030), with a history of depression (<em>p</em> <!-->=<!--> <!-->0.003) and positive for RF at baseline (<em>p</em> <!-->=<!--> <!-->0.014) in the switch group.</p><p>In the multivariate analysis, anti-TNF-α agents use (OR 8.3, 95% CI 2.4–28.8, <em>p</em> <!-->=<!--> <!-->0.001), tobacco exposure (OR 2.3, 95% CI 1.1–4.8, <em>p</em> <!-->=<!--> <!-->0.02) and history of depression (OR 3.1, 95% CI 1.3–7.7) seem to predict the need to switch in the first year of treatment due to ineffectiveness.</p></div><div><h3>Discussion and conclusion</h3><p>In our study, tobacco exposure and depression appear to be modifiable risk factors associated with early switching due to ineffectiveness. Addressing these factors in daily clinical practice is crucial to enhance the overall response to therapy and improve the well-being of patients.</p></div>\",\"PeriodicalId\":94193,\"journal\":{\"name\":\"Reumatologia clinica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Reumatologia clinica\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S217357432400100X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Reumatologia clinica","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S217357432400100X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
导言生物改良抗风湿药（bDMARD）改善了类风湿关节炎（RA）患者的临床病程和生活质量。目的 确定在治疗第一年因疗效不佳而需要换药的类风湿关节炎患者的比例，并确定特定的基线特征作为在治疗第一年因疗效不佳而换药的可能预测因素。收集了基线时的人口统计学数据、疾病特征、疾病活动数据评分、实验室参数和治疗情况。结果 共纳入了 437 名（364 名女性，83.3%）RA 患者。其中大多数患者开始使用抗 TNF-α 药物（315 人，72.1%）。有 48 名患者（11.0%）在治疗的第一年对 bDMARD 无效。在多变量分析中，使用抗肿瘤坏死因子-α药物（OR 8.3，95% CI 2.4-28.8，p = 0.001）、烟草暴露（OR 2.3，95% CI 1.1-4.8，p = 0.02）和抑郁症病史（OR 2.3，95% CI 1.1-4.8，p = 0.003）的患者明显增多。讨论与结论在我们的研究中，烟草暴露和抑郁症似乎是与因疗效不佳而提前换药相关的可调整风险因素。在日常临床实践中解决这些因素对于提高治疗的整体反应和改善患者的福祉至关重要。
Can we predict the risk factors for switching due to ineffectiveness in the first year of therapy with bDMARD in patients with rheumatoid arthritis?
Introduction
Biological disease-modifying antirheumatic drugs (bDMARD) have improved the clinical course and quality of life of patients with rheumatoid arthritis (RA). However, some patients failed to respond or have an insufficient response to bDMARD early in the course of the treatment.
Objectives
To determine the percentage of RA patients who need to switch due to ineffectiveness in the first year of treatment and to identify specific baseline features as possible predictors of switch due to ineffectiveness in the first year of treatment.
Materials and methods
An observational retrospective study was conducted with patients with RA that started their first bDMARD. Demographic data, disease characteristics, disease activity data scores, laboratory parameters and treatment at baseline were collected. The proportion of patients who failed to respond and who switched to another bDMARD in the first year of treatment was calculated.
Results
A total of 437 (364 females, 83.3%) patients with RA were included. The majority of these patients started an anti-TNF-α agent (n = 315, 72.1%). Forty-eight (11.0%) patients failed to respond to the bDMARD in the first year of treatment. There were significantly more current or former smokers (p = 0.030), with a history of depression (p = 0.003) and positive for RF at baseline (p = 0.014) in the switch group.
In the multivariate analysis, anti-TNF-α agents use (OR 8.3, 95% CI 2.4–28.8, p = 0.001), tobacco exposure (OR 2.3, 95% CI 1.1–4.8, p = 0.02) and history of depression (OR 3.1, 95% CI 1.3–7.7) seem to predict the need to switch in the first year of treatment due to ineffectiveness.
Discussion and conclusion
In our study, tobacco exposure and depression appear to be modifiable risk factors associated with early switching due to ineffectiveness. Addressing these factors in daily clinical practice is crucial to enhance the overall response to therapy and improve the well-being of patients.
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