Shuji Asai1, Takayoshi Fujibayashi2, Takeshi Oguchi3, Masahiro Hanabayashi4, Masatoshi Hayashi5, Hiroyuki Matsubara5, Takayasu Ito6, Yuichiro Yabe7, Tsuyoshi Watanabe8, Yuji Hirano9, Yasuhide Kanayama10, Atsushi Kaneko11, Takefumi Kato12, Hideki Takagi13, Nobunori Takahashi1, Koji Funahashi1, Toki Takemoto1, Nobuyuki Asai1, Tatsuo Watanabe1, Naoki Ishiguro1, Toshihisa Kojima1. 1. a Department of Orthopedic Surgery , Nagoya University Graduate School of Medicine , Nagoya , Aichi , Japan. 2. b Department of Orthopedic Surgery , Konan Kosei Hospital , Konan , Aichi , Japan. 3. c Department of Orthopedic Surgery , Anjo Kosei Hospital , Anjo , Aichi , Japan. 4. d Department of Orthopedic Surgery , Ichinomiya Municipal Hospital , Ichinomiya , Aichi , Japan. 5. e Department of Rheumatology , Nagano Red Cross Hospital , Nagano , Japan. 6. f Ito Orthopedic Clinic , Nagoya , Aichi , Japan. 7. g Department of Rheumatology , Tokyo Shinjuku Medical Center , Tokyo , Japan. 8. h Department of Orthopedic Surgery , Kariya-Toyota General Hospital , Kariya , Aichi , Japan. 9. i Department of Rheumatology , Toyohashi Municipal Hospital , Toyohashi , Aichi , Japan. 10. j Department of Rheumatology , Toyota Kosei Hospital , Toyota , Aichi , Japan. 11. k Department of Orthopedic Surgery and Rheumatology , Nagoya Medical Center , Nagoya , Aichi , Japan. 12. l Kato Orthopedic Clinic , Okazaki , Aichi , Japan. 13. m Department of Orthopedic Surgery , Nagoya Central Hospital , Nagoya , Aichi , Japan.
Abstract
OBJECTIVE: This study aimed to investigate predictors of biologic discontinuation due to insufficient response as a surrogate for relapse in patients with rheumatoid arthritis (RA) who achieved clinical remission with biologic treatment. METHODS: This study was performed based on data from a multicenter registry, and included 404 patients who achieved clinical remission within the first year of treatment with their first biologic. Cumulative retention rate of the first biologic was estimated using Kaplan-Meier curves, and the impact of patient characteristics on biologic discontinuation was assessed with Cox proportional hazards models. RESULTS: During follow-up, 50 patients discontinued their first biologic due to insufficient response. Overall discontinuation rates due to insufficient response after achieving remission were 6%, 11%, and 19% at 1, 2, and 5 years, respectively. Multivariate analysis revealed that concomitant glucocorticoids at achieving remission [hazard ratio (HR): 3.80, 95% confidence interval (CI): 1.89-7.64)] and a higher level of C-reactive protein (CRP) at achieving remission (HR: 1.47 per 1 mg/dL, 95% CI: 1.09-1.99) independently predict discontinuation due to insufficient response after achieving remission. CONCLUSION: Patients with RA who achieved remission with concomitant glucocorticoid treatment and a higher level of CRP are at high risk of subsequent biologic discontinuation due to insufficient response.
OBJECTIVE: This study aimed to investigate predictors of biologic discontinuation due to insufficient response as a surrogate for relapse in patients with rheumatoid arthritis (RA) who achieved clinical remission with biologic treatment. METHODS: This study was performed based on data from a multicenter registry, and included 404 patients who achieved clinical remission within the first year of treatment with their first biologic. Cumulative retention rate of the first biologic was estimated using Kaplan-Meier curves, and the impact of patient characteristics on biologic discontinuation was assessed with Cox proportional hazards models. RESULTS: During follow-up, 50 patients discontinued their first biologic due to insufficient response. Overall discontinuation rates due to insufficient response after achieving remission were 6%, 11%, and 19% at 1, 2, and 5 years, respectively. Multivariate analysis revealed that concomitant glucocorticoids at achieving remission [hazard ratio (HR): 3.80, 95% confidence interval (CI): 1.89-7.64)] and a higher level of C-reactive protein (CRP) at achieving remission (HR: 1.47 per 1 mg/dL, 95% CI: 1.09-1.99) independently predict discontinuation due to insufficient response after achieving remission. CONCLUSION:Patients with RA who achieved remission with concomitant glucocorticoid treatment and a higher level of CRP are at high risk of subsequent biologic discontinuation due to insufficient response.
Authors: Nancy A Shadick; Nicole M Gerlanc; Michelle L Frits; Bradley S Stolshek; Brenna L Brady; Christine Iannaccone; David Collier; Jing Cui; Alex Mutebi; Michael E Weinblatt Journal: Clin Rheumatol Date: 2019-07-29 Impact factor: 2.980