Trajectory of intensive treat-to-target disease modifying drug regimen in an observational study of an early rheumatoid arthritis cohort

摘要

Objectives Studies of early rheumatoid arthritis (RA) cohorts have analysed treatment response and prognostic factors at fixed time points. However, in treat-to-target protocols, therapeutic decision-making is dynamic and responsive to disease activity over time. To determine when a minimal residual disease response target should be expected, our primary objective was to identify the time-dependent therapeutic response to combination disease modifying antirheumatic drugs (DMARDs) for 12?months. Our secondary objective determined factors affecting this response trajectory. Design Observational cohort. Setting Treat-to-target early RA clinic in Australian tertiary referral hospital. Participants We enrolled consecutive patients attending an early arthritis clinic with symptom duration less than 12?months, who were diagnosed with RA for the first time between 2004 and 2008. 101 met these eligibility criteria and data were available at baseline through 12?months. Interventions intensive DMARDs according to a treat-to-target protocol. Primary and secondary outcome measures We measured disease activity scores (DAS) at each visit, then analysed therapeutic response and associated factors in a time-dependent fashion over 12?months. Results The median DAS4vESR of 4.46 at baseline decreased 12?weeks later by 24%, while the proportion with DAS4v?≤?2.6 increased (p0.01). DAS4v continued to decrease over 52?weeks. DAS4v reduction of at least ?0.45 at 4?weeks was predictive of DAS4v at 28 and 52?weeks. Female gender, current smoking, primary education and an interaction between baseline weight and C reactive protein (CRP) negatively impacted DAS4v reduction over 4 and 52?weeks. Time-varying effects of blood pressure, neutrophils, erythrocyte sedimentation rate and CRP also significantly influenced DAS4v over 52?weeks. Conclusions Time-dependent data suggest that the largest reduction of DAS4v to combination DMARDs occurs in the first month of therapy, and this predicts subsequent response. Variables known to impact long-term treatment response in RA also impacted early DAS4v response to combination DMARDs.