Optimizing therapy in inflammatory arthritis: prediction of relapse after tapering or stopping DMARDS/ biologic agents by ultrasonographic assessment in rheumatoid arthritis patients who achieved clinical remission (Record no. 76412)
[ view plain ]
| 000 -LEADER | |
|---|---|
| fixed length control field | 03917cam a2200169 4500 |
| 001 - CONTROL NUMBER | |
| control field | NMDX7562 |
| 008 - FIXED-LENGTH DATA ELEMENTS--GENERAL INFORMATION | |
| fixed length control field | 120401t2016 xxu||||| |||| 00| 0 eng d |
| 100 ## - MAIN ENTRY--PERSONAL NAME | |
| Personal name | Palmer, D. |
| 240 ## - UNIFORM TITLE | |
| Uniform title | <a href="Annals of the Rheumatic Diseases">Annals of the Rheumatic Diseases</a> |
| 245 ## - TITLE STATEMENT | |
| Title | Optimizing therapy in inflammatory arthritis: prediction of relapse after tapering or stopping DMARDS/ biologic agents by ultrasonographic assessment in rheumatoid arthritis patients who achieved clinical remission |
| 260 ## - PUBLICATION, DISTRIBUTION, ETC. (IMPRINT) | |
| Date of publication, distribution, etc. | 2016 |
| 500 ## - GENERAL NOTE | |
| General note | NMUH Staff Publications |
| 500 ## - GENERAL NOTE | |
| General note | EMBASE |
| 500 ## - GENERAL NOTE | |
| General note | 75 |
| 520 ## - SUMMARY, ETC. | |
| Summary, etc. | <span style="font-size: 10pt;">Background: In contrast to initiation of biologic therapy, guidelines regarding stopping of this treatment are missing. As a result, the decision of discontinuation is still a challenging aspect in the use of biologic therapy. Currently this is typically based on an estimated, case-by-case, benefit-risk ratio. Objectives: To assess whether joint ultrasonography can predict disease relapse in RA patients in sustained remission, either continuing, tapering or stopping Disease modifying drugs (DMARDs) or biologic therapy in a prospective randomized study. Methods: 157 RA patients in clinical remission, (Disease Activity Score in 28 joints [DAS-28] &lt;2.6 for more than 6-months) receiving treatment with DMARDs and biologic therapy, were randomized into four arms: Arm 1: continue full dose DMARDs and taper biologic therapy by 50% (31 patients); Arm 2: taper both DMARDs and biologic therapy dose by 50% (32 patients); Arm 3: taper DMARDs by 50% and stop biologic therapy (31 patients); Arm 4: stop both DMARDs and biologic therapy (31 patients). Patients' joints were assessed ultrasonographically (Gray scale and Power Doppler) at 40 joints (DAS28 joints + ankles + metatarsophalangeal joints) and were prospectively followed up bi-monthly for 12-months. Control group (32 RA patients) continued their DMARDs and biologic therapy at the same doses. Physicians who evaluated the patients during the study period were blinded to the baseline ultrasound findings. The primary endpoint was sustained remission during 12 months. Patients were considered as having a relapse when the DAS-28 score was &gt;3.2 and anti-rheumatic treatment was escalated. Results: The incidence of relapses was related to study arms: Arm 1: relapse 41.9%, arm 2: 59.3%; arm 3: 67.7%; Arm 4: 77.4%. Kapler-Meier Analysis revealed that time to relapse also varied in the 4 study subgroups: Arm 1: 6.8 +/- 2.46; Arm 2: 5.3 +/- 2.6; Arm 3: 4.7 +/- 2.2; Arm 4: 3.9 +/- 2.1 months. Relapse rates were significantly higher in patients whose total ultrasound scores at discontinuation were high than in those whose total ultrasound scores were low (P&lt;0.001 for both total gray-scale and power Doppler scores). Positive and negative predictive values were 84.7% and 71.2% for the total Gray-scale score and 89.8% and 73.5% for the total power Doppler score, respectively. Multivariate logistic regression identified anti-citrullinated protein antibodies (ACPA) positivity (p=0.027) and treatment reduction (in comparison to continuation) as predictors for relapse (arm 1: p 0.004, arm 2: p=0.002; arm 3: p=0.003, arm 4: p=0.001). Conclusions: Less than 40% of the patients remained in remission after tapering or stopping DMARDs and biological therapy. In RA patients in clinical remission, residual synovial inflammation determined by joint ultrasonographic assessment predicted relapse within a short term after discontinuation of the treatment. Relapses occurred mainly in the first 6 months after treatment reduction or stoppage and were associated with the presence of ACPA. This data endorse the establishment of ultrasound-based strategies before optimizing biologic/ DMARs therapy in RA is considered.&nbsp;[Conference Abstract]</span> |
| 856 ## - ELECTRONIC LOCATION AND ACCESS | |
| Uniform Resource Identifier | <a href="http://ard.bmj.com/content/annrheumdis/75/Suppl_2/156.1.full.pdf">http://ard.bmj.com/content/annrheumdis/75/Suppl_2/156.1.full.pdf</a> |
| Withdrawn status | Lost status | Damaged status | Not for loan | Collection code | Home library | Current library | Shelving location | Date acquired | Total Checkouts | Date last seen | Price effective from | Koha item type |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Staff publications for NMDX | Ferriman information and Library Service (North Middlesex) | Ferriman information and Library Service (North Middlesex) | Shelves | 07/06/2022 | 07/06/2022 | 07/06/2022 | Book |