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THU0218 FAST REMISSION RESPONSE TO ETANERCEPT PREDICTS MAINTENANCE OF CLINICAL AND RADIOLOGICAL REMISSION IN RHEUMATOID ARTHRITIS B. Raffeiner 1, 2,*, C. Botsios 1, F. Ometto 1, P. Sfriso 1, M. Canova 1, L. Bernardi 1, C. Vezzari 1, S. Todesco 1, L. Punzi 1 1Rheumatology Unit, University of Padova, Padova, 2Rheumatology Unit, Internal Medicine Hospital Bolzano, Bolzano, Italy Background: Functional outcome of patients with rheumatoid arthritis (RA) depends from rapid achievement of disease remission to prevent radiological damage. The use of biologic agents early in the course of RA has resulted more efficacious than in established RA. One of the characteristics of anti-TNF blockers is the speed of clinical response, and can already be seen in the first 2 weeks of treatment, as has been demonstrated with adalimumab in the PREMIER study, with infliximab in the ASPIRE study, with etanercept (ETA) in the ERA study, and recently with certolizumab pegol. Inhibition of the radiological progression can be observed even at 16 weeks of starting anti-TNF blocker (1). The early responders at 6 weeks had a higher probability of achieving improved quality of life and significantly better symptom control than responders at week 12 (2). The fast induction of remission is associated with better long-term improvements than delayed response. Objectives: To establish rates of fast (first month) and slow remission responders (>first month) among RA cohort treated with ETA. To determine effects of fast versus slow remission response on maintenance of clinical and radiological remission. Methods: Retrospective observational study was
performed on RA patients who started ETA therapy from 2004 to 2010
because of moderate to severe disease activity. Results: 68 of total 176 RA patients reached
DAS28 remission within the first treatment month with ETA and were
classified as fast remission responders (38,6%). Only 7 of 68 fast
remission responders (8,1%) lost disease control by ETA in
follow-up (mean 3,5 years) compared with 23,1% of slow remission
responders (25 out of 108; p<0,05). Considering
patients with early RA (disease duration ≤ 4 years) difference was
significant too (16,6 vs 64,7%; p<0,05). No
difference was found for analyzed patients’ baseline
characteristics. Radiological progression (ΔTSS>1)
occurred in 6% of fast but 13,3% of slow remission
responders. Conclusions: Fast remission response to ETA is achieved in one third of RA patients with early and established disease, and determines better outcome by greater maintenance of clinical and radiological remission compared to slow remission response. References: 1. Van der Heijde DM et al. Arthritis Rheum 2008;58(Suppl):51. 2. Keystone EC et. al. Ann Rheum Dis 2009;68(Suppl3):225. |
依那西普速诱导RA快速缓解预示临床和放射学持久缓解 B. Raffeiner. EULAR 2011. Present No: THU0218 背景：类风湿性关节炎患者功能预后取决于病情快速缓解以阻止放射学损害。RA病程早期使用生物制剂比确诊RA后使用更加有效。抗肿瘤坏死因子拮抗剂的一个特征是临床反应迅速，在治疗的前两周即可观察到。这在阿达木单抗的PREMIER研究，英利昔单抗的ASPIRE研究、依那西普的ERA研究，以及最近的塞妥珠单抗研究中均已得到证实。抗肿瘤坏死因子拮抗剂使用16周时可以观察到放射学进展被阻止。和第12周才有反应的患者相比，第6周即有疗效反应的患者有更高的比例可以获得生活质量的改善和更好的控制临床症状。和延迟的缓解反应相比，快速诱导缓解有更好的长期改善。 目标：对使用依那西普治疗的RA患者，通过建立快速缓解（一月内）和慢速缓解患者（大于一月）的比率，来确定相比慢速缓解，快速缓解对维持临床和放射学缓解的效应。 方法：对2004年到2010年因中度到重度RA活动而开始使用依那西普治疗的患者进行回顾性观察研究。对在开始使用依那西普治疗后一月内达到DAS28评分缓解者定义为快速缓解患者，一月之后达到DAS28评分缓解者 定义为慢速缓解患者。6月内不能达到或维持DAS28评分缓解的患者被排除。对快速缓解患者和慢速缓解患者两组之间，比较依那西普治疗后临床缓解的持续程度。同时基线和一年后进行X线检查，并做改良的Sharp总评分(TSS)，比较两组放射学进展情况。同时比较两组之间的年龄、性别、病程时间、基线时DAS28评分和PCR、先前的治疗情况以及合并治疗。统计分析使用标准T检验，需要时使用Pearson 检验。 结果：在使用依那西普治疗的第一月内，所有176名RA患者中68人达到DAS28缓解，这些患者被定义为快速缓解患者（38.6%）。68名快速缓解患者中只有7人在随后的依那西普治疗中（平均3.5年）不能稳定控制病情，而慢速缓解患者组中不能稳定控制病情比例为23.1%（108名患者中25人），两组相比p<0.05。早期RA患者（病程小于4年）两组有显著差异（16.6% vs 64.7%；p<0.05）。两组其他基线特征没有差异。放射学进展（治疗后TSS评分-治疗前TSS评分>1）在快速缓解组为6%，慢速缓解组为13.3%。 结论：1/3的RA患者使用依那西普治疗可以获得快速缓解，与慢速缓解患者相比，这些患者临床和放射学缓解更持久，从而预后更好。 |