类风湿关节炎达标治疗最优方法3个月时间

类风湿关节炎达标治疗最优方法：3个月时间点策略背景

达标治疗（T2T）为广泛接受的风湿性关节炎管理策略，并且治疗启动后3个月时为关键决定点。在此时间点时，目前仍不清楚哪些患者将从治疗调整或继续现有治疗中获益。

方法

我们对RA患者水平临床试验数据的汇总分析。我们通过诊断测试方法以及采用Logistic回归的概率法，评估3个月时何种应答水平能够就6个月时实现目标提供治疗决策。

结果

就至少80%敏感性实现6个月时低疾病活动性而言，需要在3个月时观察到简化疾病活动指数/临床疾病活动指数（SDAI或CDAI）发生58%变化。敏感预测缓解（REM）需要更大变化。未达到（较小）SDAI50%应答水平的患者阴性似然比极低（LR）（6个月时实现LDA为0.28，实现REM为0.07）。达到（较大）SDAI85%应答具有显著阳性LR；6个月时实现LDA为9.2，实现REM为6.2。在Logistic回归中，3个月时变化与6个月时实现目标具有显著相关性。

结论

3个月时间点为关键决定点。3个月时未达到较小应答意味着6个月时极不可能实现治疗目标，达到较大应答则高度预测实现治疗目标。

Optimisationofatreat-to-targetapproachinrheumatoidarthritis:strategiesforthe3-monthtimepointBackground

Treat-to-target(T2T)isawidelyacceptedmanagementstrategyforrheumatoidarthritis(RA)withakeydecisionpointat3monthsaftertreatmentinitiation.Atthistimepointremainsunclearwhichpatientswillbenefitfromtreatmentadaptationorfromcontinuationofexistingtreatment.

Methods

Weperformedapooledanalysisofpatient-levelclinicaltrialdataofpatientswithRA.Weusedadiagnostictestingmethodologyandaprobabilisticapproachemployinglogisticregressiontoinvestigatewhichlevelsofresponseat3monthscaninformtreatmentdecisionsinregardtoachievingthetargetat6months.

Results

Tobeatleast80%sensitiveforachievingthelowdiseaseactivity(LDA)targetat6months,achangeat3monthsinSimplifiedDiseaseActivityIndex/ClinicalDiseaseActivityIndex(SDAIorCDAI)of58%needstobeobservedat3months.Higherchangesareneededtosensitivelypredictremission(REM).Notreachingthe(minor)SDAI50%responselevelisafflictedwithverylownegativelikelihoodratios(LRs)(0.28forLDAand0.07forREMat6months).Experiencing(major)SDAI85%responsehassubstantialpositiveLRsof9.2forreachingLDAand6.2forreachingREMat6months.Inlogisticregression,thechangeat3monthsissignificantlyassociatedwithreachingofthetargetat6months.

Conclusions

The3-monthtimepointisacriticaldecisionpoint.Notachievingminorresponsesat3monthsmakesreachingofthetreatmenttargetat6monthshighlyunlikely,whilereachingmajorresponsesishighlypredictiveofreachingthetreatmenttarget.

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