Prediction of disease flare by biomarkers after discontinuing biologics in patients with rheumatoid arthritis achieving stringent remission
| Autor: | S. Takenaka, Hideto Kameda, H. Ito, K. Mizushina, A. Hirata, Takehisa Ogura, Yuto Takakura, Yuki Inoue, Takaharu Katagiri |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Science Disease Severity of Illness Index Article law.invention Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine Medical research Rheumatology law Internal medicine medicine Clinical endpoint Humans In patient Aged 030203 arthritis & rheumatology Biological Products Multidisciplinary business.industry Remission Induction Middle Aged medicine.disease Symptom Flare Up Discontinuation 030104 developmental biology Treatment Outcome Withholding Treatment Rheumatoid arthritis Antirheumatic Agents Medicine Biomarker (medicine) Female business Biomarkers Blood sampling Flare |
| Zdroj: | Scientific Reports Scientific Reports, Vol 11, Iss 1, Pp 1-9 (2021) |
| ISSN: | 2045-2322 |
| Popis: | To elucidate the disease-flare process in rheumatoid arthritis (RA) after discontinuing biological disease-modifying antirheumatic drugs (bDMARDs), we first focused on RA-flare prediction after achieving stringent remission criteria. Patients with RA who maintained a simplified disease activity index ≤ 3.3 for ≥ 3 months during November 2014–January 2018 in our medical centre in Tokyo, Japan, were eligible. The primary endpoint was flare (disease activity score 28—erythrocyte sedimentation rate ≥ 3.2 with increase from baseline > 0.6) within 2 years after bDMARD discontinuation. Comprehensive clinical assessments, ultrasonographic evaluation of 40 joints, and blood sampling for 12 biomarkers were performed every 2–3 months for 2 years unless patients experienced flare. Flare-positive and flare-negative patients were compared using univariate and Kaplan–Meier analyses. Thirty-six patients (80.6% female, median disease duration, 5.2 years; median treatment period with discontinued bDMARD, 2 years; median remission duration, 18 months) were enrolled. Twenty patients (55.6%) experienced RA flare 43–651 (median, 115) days after the first skipped date of bDMARDs. Two patients who withdrew without disease flare were excluded from the comparison. Clinical and ultrasonographic evaluations did not show significant between-group differences; Kaplan–Meier analysis showed that higher baseline soluble tumour necrosis factor receptor 1 (sTNFR1) concentration impacted subsequent disease flare (p = 0.0041); higher baseline interleukin (IL)-2 concentration was exclusively beneficial to patients with lower sTNFR1 (p = 0.0058), resulting in remission maintenance in 83.3% of patients with lower sTNFR1 and higher IL-2. We demonstrated the usefulness of combined biomarker evaluation for predicting sustained remission after bDMARD discontinuation in RA. |
| Databáze: | OpenAIRE |
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