[类风湿关节炎患者在使用生物改变病情抗风湿药和 Janus 激酶抑制剂治疗的背景下对糖皮质激素需求的减少：来自临床实践的证据]。

IF 0.3 4区医学 Q3 MEDICINE, GENERAL & INTERNAL Terapevticheskii Arkhiv Pub Date : 2024-06-03 DOI:10.26442/00403660.2024.05.202701

A S Potapova, A E Karateev, E Y Polishchuk, E S Filatova, V N Amirdzhanova, A M Lila

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引用次数: 0

摘要

背景：目的：确定在实际临床实践中取消糖皮质激素和减少剂量的频率，同时考虑到积极的RA治疗：研究组由 303 名符合 ACR/EULAR 标准的 RA 患者组成（女性 79.9%，年龄 52.8±13.3，病程 9 [4; 16]年，DAS-28-CRP 4.9±1.0，RF 血清阳性率 77.4%，ACPA 血清阳性率 70.这些患者由于病情加重或之前的治疗无效，被处方或更换了改善病情抗风湿药（DMARDs）、生物改善病情抗风湿药（bDMARDs）或Janus激酶抑制剂（iJAK）。所有患者最初都接受了 GC（7.7±3.8 mg/天，相当于泼尼松龙）治疗。调整疗法后，42.9%的患者接受甲氨蝶呤治疗，27.6%接受来氟米特治疗，2.5%接受柳氮磺胺吡啶、羟氯喹或与非类固醇抗炎药物联合治疗，63.7%接受bDMARDs治疗，7.2%接受iJAK治疗。在随访开始 6 个月后，通过电话调查评估是否需要摄入 GC：274人（90.4%）接受了电话调查。疼痛强度（数字评分量表，NRS 0-10）从 6.3±1.4 降至 4.3±2.4 （ppp 结论：在强化 RA 治疗的背景下，患者的疼痛强度明显降低：在RA强化治疗的背景下，包括DMARDs与bDMARDs或iJAK的联合治疗，6个月后只有不到一半（45.6%）的患者完全停用或减少了GC的剂量。

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[Reduction in the need for glucocorticoids on the background of therapy with biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors in rheumatoid arthritis: evidence from real clinical practice].

Background: Clinical guidelines for the treatment of rheumatoid arthritis (RA) recommend reducing the use of glucocorticoids (GCs) due to the high risk of associated complications.

Aim: To determine the frequency of GC cancellations and dose reductions in real clinical practice, while taking into account active RA therapy.

Materials and methods: The study group consisted of 303 patients with RA reliable according to ACR/EULAR criteria (women 79.9%, age 52.8±13.3, disease duration 9 [4; 16] years, DAS-28-CRP 4.9±1.0, RF seropositivity 77.4%, ACPA seropositivity 70.3%), who were prescribed or changed therapy with disease-modifying antirheumatic drugs (DMARDs), biologic disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase inhibitors (iJAK) due to disease exacerbation and ineffectiveness of previous treatment. All patients initially received GC (7.7±3.8 mg/day equivalent of prednisolone). After adjustment of therapy, 42.9% of patients received methotrexate, 27.6% leflunomide, 2.5% sulfasalazine, hydroxychloroquine, or a combination with an Non-steroidal anti-inflammatory drugs, 63.7% bDMARDs, and 7.2% iJAK. The need for GC intake was assessed by a telephone survey conducted 6 months after the start of follow-up.

Results: Telephone survey was possible in 274 (90.4%) persons. There was a significant decrease in pain intensity (numerical rating scale, NRS 0-10) from 6.3±1.4 to 4.3±2.4 (p<0.001), fatigue (NRS) from 6.7±2.3 to 5.2±2.1 (p<0.001), and functional impairment (NRS) from 5.4±2.1 to 3.9±2.0 (p<0.001). A positive PASS index (symptom status acceptable to patients) was noted in 139 (50.7%) patients. GC cancellation was noted in 19.7%, dose reduction in 25.9%, maintaining the same dose in 42.7%, and dose increase in 11.7%.

Conclusion: Against the background of intensive RA therapy, including combination of DMARDs with bDMARDs or iJAK, complete withdrawal or reduction of GC dose was achieved in less than half (45.6%) of patients after 6 months.

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来源期刊

Terapevticheskii Arkhiv 医学-医学：内科

CiteScore

1.40

自引率

33.30%

发文量

171

审稿时长

3-8 weeks

期刊介绍： Терапевтический архив The journal was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal. Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases. The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists. The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal. The journal is indexed in RSCI (Russian Science Citation Index), PubMed/Medline, Index Medicus, Scopus/EMBASE, Web of Science Core Collection (Science Citation Index Expanded), Web of Science (Russian Science Citation Index - RSCI, Current Contents Connect, BIOSIS Previews), Google Scholar, Ulrich''s Periodicals Directory. The journal is included in the list of periodicals recommended by the Higher Attestation Committee for publishing the papers containing the basic materials of doctoral and candidate dissertations. By the decision of the Presidium of the Russian Academy of Medical Sciences, the “Therapevticheskiy Arkhiv” was awarded the Botkin medal. It was admitted to the European Association of Sciences Editors (EASE). The journal was honored with the Golden Press Fund decoration at the 13th International Press Professional Exhibition.