Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis
Currently, a large number of highly effective biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) are used for the treatment of rheumatoid arthritis (RA). However, in addition to effectiveness, it is necessary to evaluate the risk of adverse events (AEs)...
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| Language: | Russian |
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IMA-PRESS LLC
2022-12-01
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| Series: | Современная ревматология |
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| Online Access: | https://mrj.ima-press.net/mrj/article/view/1368 |
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| author | E. N. Koltsova G. V. Lukina E. I. Schmidt K. A. Lytkina E. V. Zhilyaev |
| author_facet | E. N. Koltsova G. V. Lukina E. I. Schmidt K. A. Lytkina E. V. Zhilyaev |
| author_sort | E. N. Koltsova |
| collection | DOAJ |
| description | Currently, a large number of highly effective biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) are used for the treatment of rheumatoid arthritis (RA). However, in addition to effectiveness, it is necessary to evaluate the risk of adverse events (AEs) when using them.Objective: to determine the predictors of bDMARDs and tsDMARDs discontinuation due to AEs in patients with RA.Patients and methods. The study included 661 patients with RA who took bDMARDs and tsDMARDs. The search for predictors of targeted therapy discontinuation due to AEs was carried out in two stages. At the first stage, using the Kaplan-Meier method, we selected indicators that showed the greatest significant single-factor relationship with the duration of retention on therapy. At the second stage, significant independent indicators were obtained by iterative selection of variables within the multivariate proportional risk model according to Cox.Results and discussion. The presence of rheumatoid nodules (p<0.001), high doses of glucocorticoids (GC; p<0.001), low doses of methotrexate (MT; p=0.009) are significant independent factors for increasing the risk of drugs discontinuation due to the development of AEs. The type of bDMARDs/tsDMARD used also significantly correlated with the risk of discontinuation of therapy due to AEs. A relatively high risk of treatment discontinuation was observed with infliximab (IFN) and certolizumab pegol (CZP). Cancellation of IFN was associated with the occurrence of infusion reactions and infectious complications, and CZP was associated with infectious complications.Conclusion. An increase in the dose of MT and decrease in the use of GCs can help prevent the development of AEs leading to the abolition of biologics and tsDMARDs. Significant differences were found between bDMARDs in terms of the risk of their cancellation due to AEs. |
| first_indexed | 2024-04-10T02:05:53Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1996-7012 2310-158X |
| language | Russian |
| last_indexed | 2024-04-10T02:05:53Z |
| publishDate | 2022-12-01 |
| publisher | IMA-PRESS LLC |
| record_format | Article |
| series | Современная ревматология |
| spelling | doaj.art-fc2ba8e360ac476996209d73be23f6752023-03-13T08:39:30ZrusIMA-PRESS LLCСовременная ревматология1996-70122310-158X2022-12-01166263110.14412/1996-7012-2022-6-26-312533Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritisE. N. Koltsova0G. V. Lukina1E. I. Schmidt2K. A. Lytkina3E. V. Zhilyaev4Московский клинический научный центр им. А.С. Логинова Департамента здравоохранения города МосквыМосковский клинический научный центр им. А.С. Логинова Департамента здравоохранения города Москвы; Научно-исследовательский институт ревматологии им. В.А. НасоновойГородская клиническая больница № 1 им. Н.И. ПироговаГоспиталь для ветеранов войн №3Европейский Медицинский Центр; Российская медицинская академия непрерывного профессионального образования; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаCurrently, a large number of highly effective biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) are used for the treatment of rheumatoid arthritis (RA). However, in addition to effectiveness, it is necessary to evaluate the risk of adverse events (AEs) when using them.Objective: to determine the predictors of bDMARDs and tsDMARDs discontinuation due to AEs in patients with RA.Patients and methods. The study included 661 patients with RA who took bDMARDs and tsDMARDs. The search for predictors of targeted therapy discontinuation due to AEs was carried out in two stages. At the first stage, using the Kaplan-Meier method, we selected indicators that showed the greatest significant single-factor relationship with the duration of retention on therapy. At the second stage, significant independent indicators were obtained by iterative selection of variables within the multivariate proportional risk model according to Cox.Results and discussion. The presence of rheumatoid nodules (p<0.001), high doses of glucocorticoids (GC; p<0.001), low doses of methotrexate (MT; p=0.009) are significant independent factors for increasing the risk of drugs discontinuation due to the development of AEs. The type of bDMARDs/tsDMARD used also significantly correlated with the risk of discontinuation of therapy due to AEs. A relatively high risk of treatment discontinuation was observed with infliximab (IFN) and certolizumab pegol (CZP). Cancellation of IFN was associated with the occurrence of infusion reactions and infectious complications, and CZP was associated with infectious complications.Conclusion. An increase in the dose of MT and decrease in the use of GCs can help prevent the development of AEs leading to the abolition of biologics and tsDMARDs. Significant differences were found between bDMARDs in terms of the risk of their cancellation due to AEs.https://mrj.ima-press.net/mrj/article/view/1368ревматоидный артритгенно-инженерные биологические препаратытаргетные иммуносупрессорынежелательные явленияинфекционные осложнения |
| spellingShingle | E. N. Koltsova G. V. Lukina E. I. Schmidt K. A. Lytkina E. V. Zhilyaev Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis Современная ревматология ревматоидный артрит генно-инженерные биологические препараты таргетные иммуносупрессоры нежелательные явления инфекционные осложнения |
| title | Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis |
| title_full | Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis |
| title_fullStr | Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis |
| title_full_unstemmed | Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis |
| title_short | Predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis |
| title_sort | predictors of biologic disease modifying antirheumatic drugs withdrawal due to the development of adverse events in patients with rheumatoid arthritis |
| topic | ревматоидный артрит генно-инженерные биологические препараты таргетные иммуносупрессоры нежелательные явления инфекционные осложнения |
| url | https://mrj.ima-press.net/mrj/article/view/1368 |
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