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*Only for medical professionals to read for reference.
The world is big and there are no surprises! The 2021 European League Against Rheumatism (EULAR) Annual Meeting was successfully held from June 2nd to 5th.
The related reports on the theme of "Prognosis, Predictive Factors and Outcomes of Rheumatoid Arthritis" in this meeting caused enthusiastic Discussion
.
The meeting was chaired by two chairmen Martin Aringer and Alexandre Sepriano, and scholars from Italy, France, Germany and other countries were invited to participate in the seminar
.
Below we will approach the exhibition of cutting-edge academic achievements related to rheumatoid arthritis (RA)
.
1.
Ambient air pollution can cause RA to cause rapid development of human society to a certain extent at the cost of the environment, and this also has a negative impact on human life and health
.
In recent years, it has been discovered that ambient air pollution is related to the pathogenesis of RA
.
However, there is currently a lack of evidence linking higher concentrations of air pollutants with the risk of RA recurrence.
In this regard, Professor Giovanni and his collaborators from the Department of Rheumatology, University of Verona, Italy conducted further research
.
The research team collected longitudinal data of RA patients and the daily concentration of air pollutants in Verona, and designed a case crossover study to compare the pollutant exposure during the 30 days and 60 days before the onset of RA
.
Figure 1 Case cross design study Figure 2 Particulate matter and C-reactive protein (CRP) cross-sectional analysis Figure 3 Case cross results The research team conducted such a study in the Verona region (Veneto, Italy) located in the center of the trough, which is Europe One of the most industrialized and polluted areas
.
The researchers followed a group of patients for more than 5 years longitudinally and analyzed the collected data.
Professor Giovanni concluded that exposure to high concentrations of air pollutants (ie CO, NG, NO2, NOx, PM10 and PM2.
5) and increased CRP levels It is associated with an increased risk of arthritis attacks, and this additional risk is evident at very low exposure levels
.
Two RA patients taking TNFi and TOFA have similar discontinuation rates.
Tofacitinib (TOFA) is an oral small molecule drug used to treat RA.
It is the first or alternative choice of biological disease-improving anti-rheumatic drugs (bDMARD), including Tumor Necrosis Factor Inhibitor (TNFi)
.
Previously, the Ontario Best Practice Research Program (OBRI) and the Quebec cohort RHUMADATA independently reported similar retention rates for TNFi and TOFA
.
In order to improve the effectiveness of the study, Professor Mohammad of the Toronto General Hospital Research Institute and his collaborators used the aggregated data of the two registries to evaluate the discontinuation rate of TNFi and TOFA
.
A total of 1318 RA patients started to receive TNFi (n=825) or TOFA (n=493) treatment
.
During an average follow-up of 23.
2 months, 309 (37.
5%) and 182 (36.
9%) patients taking TNFi and TOFA, respectively, reported discontinuation
.
After adjusting the propensity score decile of the 20 estimated data sets, there was no significant difference in discontinuation between the treatment groups (adjusted HR: 0.
96, 95% CI: 0.
78-1.
18; p=0.
69)
.
Figure 4 The relationship between drug retention rate and treatment time (months), the blue line is TNFi, and the red line is TOFA.
Figure 4 shows the inverse probability treatment weighted and adjusted KM survival curve, comparing the stopping of patients treated with TNFi and TOFA Drug rate
.
In this pooled real-world data study, the researchers found that the survival rates of TNFi and TOFA in RA patients were similar
.
Three RF/ACPA serum status and treatment lines have an impact on the survival rate of abatacept in RA patients.
Studies have found that predictive biomarkers, such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), may be helpful To stratify RA patients to help them get the most appropriate treatment
.
In addition, ASCORE is a 2-year, observational, prospective, multi-center research on the treatment of RA, which has attracted the interest of Professor Rieke, a German rheumatologist
.
Based on this, they explored whether the RF/ACPA serum status and treatment line affect the retention of abatacept in RA patients in the post-mortem analysis of ASCORE
.
The real post-analysis results of the ASCORE study are as follows: Figure 5 Abatacept retention rate of different treatment lines Figure 6 Abatacept retention rate of serogroups Figure 7 LDA divided by RF/ACPA status and treatment line at 24 months /Remission rate Note: CDAI: clinical disease activity index; SDAI: simplified disease activity index
.
RA patients receiving first-line abatacept therapy (Figure 5, left) have a higher survival rate than RA patients receiving abatacept as second-line therapy (Figure 5, right)
.
Compared with RF/ACPA (-/-) RA (Figure 6 right), patients with RF/ACPA (+/+) RA (Figure 6 left) have a higher response rate with abatacept (regardless of whether it is used as a first-line treatment)
.
The CDAI/SDAI of patients with RF/ACPA(+/+) RA who received first-line abatacept were lower than those who received abatacept as second-line treatment (Figure 7)
.
These results support the use of abatacept for early treatment of RA patients and emphasize the importance of further evaluation of precision medical methods for RA
.
4.
A 10-year study of early RA patients ESPOIR is a prospective, multi-center observation cohort study of early RA patients in France.
In the context of this research, Professor Bernard and his collaborators from La Peroni Hospital in France carried out Further study, report the 10-year results of the initial cohort of early RA patients, the ESPOIR cohort, and outcome predictors
.
From 2003 to 2005, 813 patients with early-stage arthritis (<6 months) who were very likely to develop RA but who had never used disease-improving anti-rheumatic drugs (DMARDs) were enrolled
.
Multivariate regression analysis is used to evaluate the predictors of the outcome
.
Figure 8 The 10-year results of HAQ-DI in the ESPOIR cohort.
A total of 521 (64.
1%) RA patients were followed for 10 years, of which 35 (4.
3%) patients died, which is similar to the French general population
.
In the 10th year, the average DAS28 ESR was 2.
5±1.
3; 273 patients (52.
4%) had DAS28 remission, 39.
7% CDAI remission, 40.
1% DAS28 sustained remission and 14.
1% drug-free remission
.
Over time, disability was well controlled (Figure 8), and half of the patients had HAQ disability index <0.
5; SF-36 score and pain were well controlled
.
The structural progress was weak, and the average change in the revised Sharp score from the baseline was 11.
0±17.
9
.
A total of 82 (16.
5%) patients required joint surgery
.
Professor Bernard reported the 10-year results of the large initial cohort of early RA patients diagnosed in the early 2000s.
The results are much better than those of the early RA patient cohort recruited in 1993.
This favorable result may be more relevant to real-life patients.
Related to intensive care
.
In addition, ACPA positive has been proven to be a powerful predictor of severe long-term prognosis in patients with early RA
.
5.
Biomarkers for predicting sustained remission in RA patients In previous studies, for RA patients who used traditional synthetic DMARDs (csDMARDs) to achieve stable clinical remission (≥6 months), the management recommendation is to gradually reduce the drug (the potential purpose is to stop the drug)
.
However, there is currently no validated biomarker that can predict sustained remission.
Dr.
Hanna and his team from the Leeds Institute of Rheumatology and Musculoskeletal Medicine did further research
.
The research team designed a prospective observational study that included RA patients (n=200) who received structural tapering of csDMARDs (Table 1) or continued current treatment
.
Table 1 Drug reduction protocol Note: The order of drug reduction is hydroxychloroquine → sulfasalazine → methotrexate.
In addition to drug treatment, the study data was collected at the time of inclusion of clinical, ultrasound (US), immunology (T cell subgroups) And the patient report the outcome (PRO) data
.
Among them, loss of remission is defined as DAS28 (3v) CRP increase> 2.
6
.
Mann-Whitney-U and Chi-square test were used to compare the results
.
AUROC is used to compare models
.
Figure 9 AUROC analysis data of the cohort data of tapering drugs.
In patients who selected tapering doses, the combination of clinical, PRO, US, and T cell parameters proved the added value of predicting sustained remission (85% accuracy, Figure 9 )
.
Different biomarkers are associated with sustained remission from continuous treatment
.
Dr.
Hanna pointed out that these data may help suggest csDMARDs reduction
.
The above is part of the report under the topic "Prognosis, Predictors and Outcomes of Rheumatoid Arthritis"
.
In this EULAR online conference on RA, the presenters contributed wonderful academic sharing and discussions, and explored more research directions on RA
.
Finally, Martin Aringer and Alexandre Sepriano, chairpersons of the conference, once again thanked all participants and audiences, and the conference ended successfully
.
Reference: [1]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
216[2]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
912[3] http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
932[4]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
1063[5]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
1523
The world is big and there are no surprises! The 2021 European League Against Rheumatism (EULAR) Annual Meeting was successfully held from June 2nd to 5th.
The related reports on the theme of "Prognosis, Predictive Factors and Outcomes of Rheumatoid Arthritis" in this meeting caused enthusiastic Discussion
.
The meeting was chaired by two chairmen Martin Aringer and Alexandre Sepriano, and scholars from Italy, France, Germany and other countries were invited to participate in the seminar
.
Below we will approach the exhibition of cutting-edge academic achievements related to rheumatoid arthritis (RA)
.
1.
Ambient air pollution can cause RA to cause rapid development of human society to a certain extent at the cost of the environment, and this also has a negative impact on human life and health
.
In recent years, it has been discovered that ambient air pollution is related to the pathogenesis of RA
.
However, there is currently a lack of evidence linking higher concentrations of air pollutants with the risk of RA recurrence.
In this regard, Professor Giovanni and his collaborators from the Department of Rheumatology, University of Verona, Italy conducted further research
.
The research team collected longitudinal data of RA patients and the daily concentration of air pollutants in Verona, and designed a case crossover study to compare the pollutant exposure during the 30 days and 60 days before the onset of RA
.
Figure 1 Case cross design study Figure 2 Particulate matter and C-reactive protein (CRP) cross-sectional analysis Figure 3 Case cross results The research team conducted such a study in the Verona region (Veneto, Italy) located in the center of the trough, which is Europe One of the most industrialized and polluted areas
.
The researchers followed a group of patients for more than 5 years longitudinally and analyzed the collected data.
Professor Giovanni concluded that exposure to high concentrations of air pollutants (ie CO, NG, NO2, NOx, PM10 and PM2.
5) and increased CRP levels It is associated with an increased risk of arthritis attacks, and this additional risk is evident at very low exposure levels
.
Two RA patients taking TNFi and TOFA have similar discontinuation rates.
Tofacitinib (TOFA) is an oral small molecule drug used to treat RA.
It is the first or alternative choice of biological disease-improving anti-rheumatic drugs (bDMARD), including Tumor Necrosis Factor Inhibitor (TNFi)
.
Previously, the Ontario Best Practice Research Program (OBRI) and the Quebec cohort RHUMADATA independently reported similar retention rates for TNFi and TOFA
.
In order to improve the effectiveness of the study, Professor Mohammad of the Toronto General Hospital Research Institute and his collaborators used the aggregated data of the two registries to evaluate the discontinuation rate of TNFi and TOFA
.
A total of 1318 RA patients started to receive TNFi (n=825) or TOFA (n=493) treatment
.
During an average follow-up of 23.
2 months, 309 (37.
5%) and 182 (36.
9%) patients taking TNFi and TOFA, respectively, reported discontinuation
.
After adjusting the propensity score decile of the 20 estimated data sets, there was no significant difference in discontinuation between the treatment groups (adjusted HR: 0.
96, 95% CI: 0.
78-1.
18; p=0.
69)
.
Figure 4 The relationship between drug retention rate and treatment time (months), the blue line is TNFi, and the red line is TOFA.
Figure 4 shows the inverse probability treatment weighted and adjusted KM survival curve, comparing the stopping of patients treated with TNFi and TOFA Drug rate
.
In this pooled real-world data study, the researchers found that the survival rates of TNFi and TOFA in RA patients were similar
.
Three RF/ACPA serum status and treatment lines have an impact on the survival rate of abatacept in RA patients.
Studies have found that predictive biomarkers, such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), may be helpful To stratify RA patients to help them get the most appropriate treatment
.
In addition, ASCORE is a 2-year, observational, prospective, multi-center research on the treatment of RA, which has attracted the interest of Professor Rieke, a German rheumatologist
.
Based on this, they explored whether the RF/ACPA serum status and treatment line affect the retention of abatacept in RA patients in the post-mortem analysis of ASCORE
.
The real post-analysis results of the ASCORE study are as follows: Figure 5 Abatacept retention rate of different treatment lines Figure 6 Abatacept retention rate of serogroups Figure 7 LDA divided by RF/ACPA status and treatment line at 24 months /Remission rate Note: CDAI: clinical disease activity index; SDAI: simplified disease activity index
.
RA patients receiving first-line abatacept therapy (Figure 5, left) have a higher survival rate than RA patients receiving abatacept as second-line therapy (Figure 5, right)
.
Compared with RF/ACPA (-/-) RA (Figure 6 right), patients with RF/ACPA (+/+) RA (Figure 6 left) have a higher response rate with abatacept (regardless of whether it is used as a first-line treatment)
.
The CDAI/SDAI of patients with RF/ACPA(+/+) RA who received first-line abatacept were lower than those who received abatacept as second-line treatment (Figure 7)
.
These results support the use of abatacept for early treatment of RA patients and emphasize the importance of further evaluation of precision medical methods for RA
.
4.
A 10-year study of early RA patients ESPOIR is a prospective, multi-center observation cohort study of early RA patients in France.
In the context of this research, Professor Bernard and his collaborators from La Peroni Hospital in France carried out Further study, report the 10-year results of the initial cohort of early RA patients, the ESPOIR cohort, and outcome predictors
.
From 2003 to 2005, 813 patients with early-stage arthritis (<6 months) who were very likely to develop RA but who had never used disease-improving anti-rheumatic drugs (DMARDs) were enrolled
.
Multivariate regression analysis is used to evaluate the predictors of the outcome
.
Figure 8 The 10-year results of HAQ-DI in the ESPOIR cohort.
A total of 521 (64.
1%) RA patients were followed for 10 years, of which 35 (4.
3%) patients died, which is similar to the French general population
.
In the 10th year, the average DAS28 ESR was 2.
5±1.
3; 273 patients (52.
4%) had DAS28 remission, 39.
7% CDAI remission, 40.
1% DAS28 sustained remission and 14.
1% drug-free remission
.
Over time, disability was well controlled (Figure 8), and half of the patients had HAQ disability index <0.
5; SF-36 score and pain were well controlled
.
The structural progress was weak, and the average change in the revised Sharp score from the baseline was 11.
0±17.
9
.
A total of 82 (16.
5%) patients required joint surgery
.
Professor Bernard reported the 10-year results of the large initial cohort of early RA patients diagnosed in the early 2000s.
The results are much better than those of the early RA patient cohort recruited in 1993.
This favorable result may be more relevant to real-life patients.
Related to intensive care
.
In addition, ACPA positive has been proven to be a powerful predictor of severe long-term prognosis in patients with early RA
.
5.
Biomarkers for predicting sustained remission in RA patients In previous studies, for RA patients who used traditional synthetic DMARDs (csDMARDs) to achieve stable clinical remission (≥6 months), the management recommendation is to gradually reduce the drug (the potential purpose is to stop the drug)
.
However, there is currently no validated biomarker that can predict sustained remission.
Dr.
Hanna and his team from the Leeds Institute of Rheumatology and Musculoskeletal Medicine did further research
.
The research team designed a prospective observational study that included RA patients (n=200) who received structural tapering of csDMARDs (Table 1) or continued current treatment
.
Table 1 Drug reduction protocol Note: The order of drug reduction is hydroxychloroquine → sulfasalazine → methotrexate.
In addition to drug treatment, the study data was collected at the time of inclusion of clinical, ultrasound (US), immunology (T cell subgroups) And the patient report the outcome (PRO) data
.
Among them, loss of remission is defined as DAS28 (3v) CRP increase> 2.
6
.
Mann-Whitney-U and Chi-square test were used to compare the results
.
AUROC is used to compare models
.
Figure 9 AUROC analysis data of the cohort data of tapering drugs.
In patients who selected tapering doses, the combination of clinical, PRO, US, and T cell parameters proved the added value of predicting sustained remission (85% accuracy, Figure 9 )
.
Different biomarkers are associated with sustained remission from continuous treatment
.
Dr.
Hanna pointed out that these data may help suggest csDMARDs reduction
.
The above is part of the report under the topic "Prognosis, Predictors and Outcomes of Rheumatoid Arthritis"
.
In this EULAR online conference on RA, the presenters contributed wonderful academic sharing and discussions, and explored more research directions on RA
.
Finally, Martin Aringer and Alexandre Sepriano, chairpersons of the conference, once again thanked all participants and audiences, and the conference ended successfully
.
Reference: [1]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
216[2]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
912[3] http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
932[4]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
1063[5]http://dx.
doi.
org/10.
1136/annrheumdis-2021-eular.
1523
