Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study
Background In patients with rheumatoid arthritis (RA), glucocorticoids (GC) should be firstly discontinued before considering tapering conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) or other biological agents. We aim to determine risk factors for flare after GC withdrawal in...
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| Format: | Article |
| Language: | English |
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World Scientific Publishing
2023-11-01
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| Series: | Journal of Clinical Rheumatology and Immunology |
| Online Access: | https://www.worldscientific.com/doi/10.1142/S2661341723740218 |
| _version_ | 1797447838935810048 |
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| author | Wenhui Xie Zhuoli Zhang |
| author_facet | Wenhui Xie Zhuoli Zhang |
| author_sort | Wenhui Xie |
| collection | DOAJ |
| description | Background In patients with rheumatoid arthritis (RA), glucocorticoids (GC) should be firstly discontinued before considering tapering conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) or other biological agents. We aim to determine risk factors for flare after GC withdrawal in RA patients undergoing csDMARDs. Method RA patients who discontinued GC with continuation of csDMARD were selected from a longitudinal real-world cohort. Established RA was defined as disease duration over 12 months. Dissatisfied RA control was defined as the proportion of simplified disease activity index (SDAI)-based remission time to total time from GC initiation to discontinuation less than 50%. Logistic regression was used to analyze the independent risk factors for flare after GC discontinuation and results were expressed as odds ratio (OR). Results There were 115 eligible RA patients discounted GC with continuation of csDMARDs (methotrexate: 80%; hydroxychloroquine: 61%; csDMARDs combination: 79%). Of these, 24 patients experienced flare after GC discontinuation. Compared with relapse-free patients, flare patients were more likely to have established RA (75% vs. 49%, p=0.025), higher median cumulative prednisolone dosages (3.3g vs. 2.2g, p=0.004), and higher proportion of dissatisfied RA control during GC usage (66% vs. 33%, p=0.038). In multivariate analysis, significantly increased flare risk was predicted by established RA (OR 2.93 [1.02-8.43]), cumulative prednisolone dose > 2.5g (OR 3.69 [1.34-10.19]) and dissatisfied RA control (OR 3.00 [1.09-8.30]). Flare risk was increased with increases in number of risk factors, with highest OR of 11.56 in patients with three risk factors (p for trend=0.002). Conclusions Flare following GC withdrawal is not common in RA patients with undergoing csDMARDs therapy. Established RA, higher cumulative GC dose and dissatisfied RA control before GC discontinuation are important factors associated with flare after GC withdrawal. |
| first_indexed | 2024-03-09T14:01:46Z |
| format | Article |
| id | doaj.art-3a44b4c89c63420dbce87861b8900571 |
| institution | Directory Open Access Journal |
| issn | 2661-3417 2661-3425 |
| language | English |
| last_indexed | 2024-03-09T14:01:46Z |
| publishDate | 2023-11-01 |
| publisher | World Scientific Publishing |
| record_format | Article |
| series | Journal of Clinical Rheumatology and Immunology |
| spelling | doaj.art-3a44b4c89c63420dbce87861b89005712023-11-30T07:52:32ZengWorld Scientific PublishingJournal of Clinical Rheumatology and Immunology2661-34172661-34252023-11-0123Supp01212210.1142/S2661341723740218Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life StudyWenhui Xie0Zhuoli Zhang1Peking University First Hospital, Beijing, ChinaPeking University First Hospital, Beijing, ChinaBackground In patients with rheumatoid arthritis (RA), glucocorticoids (GC) should be firstly discontinued before considering tapering conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) or other biological agents. We aim to determine risk factors for flare after GC withdrawal in RA patients undergoing csDMARDs. Method RA patients who discontinued GC with continuation of csDMARD were selected from a longitudinal real-world cohort. Established RA was defined as disease duration over 12 months. Dissatisfied RA control was defined as the proportion of simplified disease activity index (SDAI)-based remission time to total time from GC initiation to discontinuation less than 50%. Logistic regression was used to analyze the independent risk factors for flare after GC discontinuation and results were expressed as odds ratio (OR). Results There were 115 eligible RA patients discounted GC with continuation of csDMARDs (methotrexate: 80%; hydroxychloroquine: 61%; csDMARDs combination: 79%). Of these, 24 patients experienced flare after GC discontinuation. Compared with relapse-free patients, flare patients were more likely to have established RA (75% vs. 49%, p=0.025), higher median cumulative prednisolone dosages (3.3g vs. 2.2g, p=0.004), and higher proportion of dissatisfied RA control during GC usage (66% vs. 33%, p=0.038). In multivariate analysis, significantly increased flare risk was predicted by established RA (OR 2.93 [1.02-8.43]), cumulative prednisolone dose > 2.5g (OR 3.69 [1.34-10.19]) and dissatisfied RA control (OR 3.00 [1.09-8.30]). Flare risk was increased with increases in number of risk factors, with highest OR of 11.56 in patients with three risk factors (p for trend=0.002). Conclusions Flare following GC withdrawal is not common in RA patients with undergoing csDMARDs therapy. Established RA, higher cumulative GC dose and dissatisfied RA control before GC discontinuation are important factors associated with flare after GC withdrawal.https://www.worldscientific.com/doi/10.1142/S2661341723740218 |
| spellingShingle | Wenhui Xie Zhuoli Zhang Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study Journal of Clinical Rheumatology and Immunology |
| title | Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study |
| title_full | Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study |
| title_fullStr | Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study |
| title_full_unstemmed | Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study |
| title_short | Abstract 5 — Prediction of Flare Following Glucocorticoids Withdrawal in Rheumatoid Arthritis Patients with Continuation of csDMARDs: A Real-Life Study |
| title_sort | abstract 5 prediction of flare following glucocorticoids withdrawal in rheumatoid arthritis patients with continuation of csdmards a real life study |
| url | https://www.worldscientific.com/doi/10.1142/S2661341723740218 |
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