Comparing outcomes of patients with early active rheumatoid arthritis initially treated on an inpatient or outpatient basis: a posthoc analysis of the CORRA trial.

IF 5.1 2区 医学 Q1 RHEUMATOLOGY RMD Open Pub Date : 2024-10-22 DOI:10.1136/rmdopen-2024-004430
Anna Mai, Dietmar Krause, Renate Klaassen-Mielke, Katharina Meiszl, Nina Timmesfeld, Xenofon Baraliakos, Jürgen Braun
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Abstract

Objective: Treatment strategies of patients with active rheumatoid arthritis (RA) vary within and between countries. While most patients in Germany are treated on an outpatient basis, some are hospitalised (inpatients). In the recently published randomised CORRA (CORRA, CORticoid bridging in Rheumatoid Arthritis) trial, we studied two 12 week glucocorticoid (GC) bridging strategies in patients with early RA comparing high or low GC doses with placebo, followed by an extension phase of 9 months. Here, in this posthoc analysis, we compared 12 week outcomes of patients according to their initial treatment as inpatients or outpatients.

Methods: Inpatients initially spent 2-5 days (short-term) or 14 days (long-term) in one tertiary rheumatology hospital. Outpatients were mostly treated in rheumatology practices. There was no randomisation regarding the initial treatment strategy. The main endpoint of this posthoc analysis was Clinical Disease Activity Index (CDAI) remission at weeks 4, 8 and 12.

Results: Data of 280 outpatients and 95 inpatients could be analysed. Inpatients were more often male, had less cardiovascular comorbidity, but higher baseline CDAI scores and more symptoms of depression compared with outpatients. At weeks 8 and 12, CDAI remission was more frequently observed in inpatients (week 8: 24.7 vs 14.9%; week 12: 30.5 vs 17.3%). These results were confirmed in a multivariable model: OR=2.43 (1.06; 5.55); p=0.035, and OR=2.91 (1.37; 6.14); p=0.005, respectively.

Conclusion: In early active RA, initial inpatient treatment was associated with higher CDAI remission rates at weeks 8 and 12. This may be due to the initially more intense hospital care.

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比较早期活动性类风湿关节炎患者最初在住院或门诊接受治疗的疗效:CORRA 试验的事后分析。
目的:活动性类风湿性关节炎(RA)患者的治疗策略在国内和国家之间存在差异。在德国,大多数患者在门诊接受治疗,但也有一些患者住院治疗(住院患者)。在最近发表的 CORRA(类风湿关节炎的糖皮质激素桥接疗法)随机试验中,我们对早期 RA 患者的两种为期 12 周的糖皮质激素桥接疗法进行了研究,将高剂量或低剂量的糖皮质激素与安慰剂进行了比较,随后进行了为期 9 个月的延长阶段。在这项事后分析中,我们根据患者最初接受住院或门诊治疗的情况,比较了患者12周的治疗结果:住院患者最初在一家三级风湿病医院接受 2-5 天(短期)或 14 天(长期)的治疗。门诊病人大多在风湿病诊所接受治疗。最初的治疗策略没有进行随机分配。本次事后分析的主要终点是第4、8和12周的临床疾病活动指数(CDAI)缓解情况:分析了 280 名门诊患者和 95 名住院患者的数据。与门诊患者相比,住院患者多为男性,合并心血管疾病较少,但基线 CDAI 评分较高,抑郁症状较多。在第 8 周和第 12 周,住院患者的 CDAI 缓解率更高(第 8 周:24.7% 对 14.9%;第 12 周:30.5% 对 17.3%)。这些结果在多变量模型中得到了证实:OR=2.43 (1.06; 5.55); p=0.035,OR=2.91 (1.37; 6.14); p=0.005:在早期活动性RA患者中,最初的住院治疗与第8周和第12周较高的CDAI缓解率相关。这可能是因为最初的住院治疗强度更大。
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来源期刊
RMD Open
RMD Open RHEUMATOLOGY-
CiteScore
7.30
自引率
6.50%
发文量
205
审稿时长
14 weeks
期刊介绍: RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.
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