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*Only for medical professionals to read for reference.
As one of the TARRA cohort's standard treatment series studies, this study mainly focuses on the hormone reduction in the treatment standard, and aims to provide real-world evidence for the formulation of hormone reduction strategies in RA.
Recently, the research team of Professor Zhang Zhuoli from the Department of Rheumatology and Immunology of Peking University First Hospital published an original work titled "Dynamical trajectory of glucocorticoids" in the top journal Annals of the Rheumatic Diseases ("Rheumatology Yearbook", IF=16.
102).
tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020" research paper.
It is reported that this study was independently completed by the Department of Rheumatology and Immunology of Peking University First Hospital as the sole research unit.
It revealed for the first time that under the background of traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs) treatment, patients with rheumatoid arthritis (RA) reduced glucocorticoids.
Dynamic changes and clinical characteristics of the amount and discontinuation.
As the world's first real-world study of hormone reduction and arrest under the background treatment of csDMARD, the results of this study will provide important real-world evidence for the formulation of hormone reduction strategies in RA and the optimization of the clinical use of hormones.
Figure 1 The topic of the thesis glucocorticoids still play an important role in the treatment of RA due to their potent anti-inflammatory properties.
Many clinical studies have confirmed that glucocorticoids can not only quickly and effectively control inflammation and relieve patients' joint symptoms, but also have the effect of inhibiting the progress of bone destruction.
Therefore, the European Union against Rheumatism (EULAR) management guidelines recommend that the initial treatment of RA can be combined with glucocorticoids as a bridging treatment before the onset of csDMARD, especially for RA patients with moderate to high disease activity.
Figure 2 Source: Nat Rev Rheumatol.
2016 Feb;12(2):73-4.
However, long-term glucocorticoid therapy may increase the risk of serious infections, diabetes, osteoporosis and other adverse events, even at very low doses in the case of.
Therefore, the EULAR 2019 management guidelines emphasize that hormones in RA treatment should be reduced and stopped as soon as clinically feasible, and the ideal stop time is about 3 months.
However, the current hormone reduction and stopping strategies in RA still lack evidence-based evidence, which has also led to vast differences in the use of hormones in clinical practice.
Although the EULAR management guidelines recommend that csDMARD combined with hormones can be used as the first-line treatment for RA patients, there is currently no research report on the reduction and discontinuation of hormones and clinical features under the csDMARD combined with hormone therapy.
Figure 3 Source: Nat Rev Rheumatol.
2010 Dec;6(12):693-702.
In response to this key issue, Professor Zhang Zhuoli’s research team based on the ten-year real-world RA treatment in the Department of Rheumatology and Immunology of Peking University First Hospital The cohort (Treat-TARget in RA, TARRA cohort), for the first time, fully revealed the dynamic trajectory and clinical characteristics of the reduction and withdrawal of hormones in RA patients under the background of csDMARDs treatment.
After screening the 1432 RA patients in the TARRA cohort according to the predetermined inclusion and exclusion criteria, a total of 207 RA patients with initial hormone combined with csDMARD were enrolled.
The initial median prednisolone or equivalent dose of the enrolled patients was 10 (5-10) mg/d, which decreased to 7.
5 (5-10) mg/d at the third month and decreased to 7.
5 (5-10) mg/d at the 6th month 5.
0 (2.
5-10) mg/d, until the 48th month reduced to 0 (0-5.
0) mg/d. During a median follow-up of 38.
6 months, 59.
9% (124/207) of the patients stopped using hormones.
At the 6th month, 1, 2 years, and 3 years, the cumulative hormone withdrawal rates were 9.
7%, 26.
6%, 48.
0%, and 58.
6%, respectively, and the median hormone withdrawal time was 27 months (Figure 4).
Figure 4 Kaplan Meier survival curve of cumulative hormone discontinuation rate in RA patients during follow-up.
110 patients were newly treated patients.
In these patients, the cumulative hormone discontinuation rate was 12.
7% at the 6th month, 1st year, 2nd year and 3rd year, respectively.
, 30.
0%, 50.
9% and 60.
6%, the median time to stop the hormone is 24 months.
At the same time, an analysis of patients who visited before and after 2014 found that the median time to stop hormones in RA patients after 2014 was significantly shortened, and the withdrawal rate was significantly increased (20.
0 months vs.
36.
0 months; 64.
1% vs.
56.
5% , P=0.
002).
Among the patients who stopped using hormones, more than half of the patients were in clinical remission when the hormones were stopped, and more than two-thirds of the patients had no disease recurrence within 6 months after stopping the hormones.
As the world’s first real-world study of hormone reduction and arrest under the background treatment of csDMARD, the results of this study show that for RA patients receiving hormone combined with csDMARD treatment, when the disease activity is well controlled, rheumatologists can consider stopping the hormone, and Most patients did not experience short-term recurrence after stopping hormones; however, in clinical practice, the stopping time of hormones was much longer than the time recommended by the current guidelines, which suggests that there is still a certain gap between the reduction and stopping of hormones in clinical practice and management guidelines.
The important findings of the study will provide important evidence-based evidence for the formulation of hormone reduction strategies in RA and the optimization of the clinical use of hormones.
"Rheumatology Yearbook" was founded in 1939.
It is a sub-issue of the British Medical Journal (BMJ) and the official journal of EULAR.
It is also an original journal with the highest impact factor in rheumatology.
"Rheumatism Yearbook" covers all aspects of rheumatism, including musculoskeletal system diseases, arthritis diseases, connective tissue diseases, etc.
It publishes basic, clinical and translational scientific research, including authoritative management guidelines for various diseases. In Clarivate Analytics' latest 2019 journal citation report, the journal ranked second among 32 rheumatology journals, with an impact factor of 16.
102, JCR Q1 area.
The corresponding author of the paper is Professor Zhang Zhuoli from the Department of Rheumatology and Immunology, Peking University First Hospital, and the first author is doctoral student Xie Wenhui.
This research was funded by the National Natural Science Foundation of China.
It is reported that based on the TARRA cohort, Professor Zhang Zhuoli’s research team has carried out a series of original work on the treatment of RA standards and published them in internationally renowned journals, such as the benefits of the treatment of standards in the Chinese RA population (Clin Exp Rheumatol.
2018;36:820-828 ), continuous clinical remission rate and predictive factors (Int J Rheum Dis.
2019;22:1670-1678), early clinical remission rate and predictive factors (Clin Rheumatol.
2020;39:381-389), comorbidities for achieving standard treatment Impact (Arthritis Res Ther.
2020; 22: 100), the impact of standard treatment on the progress of imaging (Clin Rheumatol.
2021; 40: 1307-1315), and the first proposed low disease activity under the Boolean definition (Rheumatol Ther.
2020 Dec 23 )Wait.
As one of the TARRA cohort's standard treatment series studies, this study mainly focuses on hormone reduction in the treatment target, and aims to provide real-world evidence for the development of hormone reduction strategies in RA.
At the same time, the research team also prospectively established a clinical follow-up cohort for systemic lupus erythematosus, a clinical follow-up cohort for psoriatic arthritis, and an RA team collaborative intensive treatment cohort (CENTRA cohort).
Based on these cohorts, the research team is continuing to carry out and publish a series of high-level studies, such as the mortality and prognostic factors of the Chinese population with systemic lupus erythematosus (Lupus.
2018;27:1742-1752) and lupus compliance status and predictive factors (Rheumatology ( Oxford).
2020;59:3400-3407). The establishment of these prospective cohorts and the publication of high-level research papers reflect that the Department of Rheumatology and Immunology of Peking University First Hospital has a world-class clinical research platform and level.
In the future, the research team will definitely develop in the field of rheumatism.
Going further, keep moving forward without forgetting the original intention.
Reference materials: [1] https://ard.
bmj.
com/content/early/2021/04/01/annrheumdis-2021-220112 Expert profile Professor Zhang Zhuoli, chief physician, professor, and doctoral supervisor, is currently the Rheumatology Department of Peking University First Hospital Director of the Department of Immunology, Deputy Chairman and Secretary-General of the Chinese Medical Association Rheumatology Group Leader of the Rheumatology Branch of the Chinese Medical Doctor Association Leader of the Imaging Group of the Rheumatology Professional Committee of the Cross-Strait Medical and Health Exchange Association Deputy Chairman of the Rheumatology Branch of the Beijing Medical Association The leader of the rheumatism group of the National Medical Examination Center of the Health Commission has long been engaged in basic and clinical research on rheumatism and immunology, and has achieved a number of original and applied results, won a number of scientific research grants and awards, and published more than 300 papers, including Ann Rheum Dis, Lancet Rheumatol, Arthritis Rheumatol, Blood, Eur Respir J, J Am Acad Dermatol, Autoimmun Rev and other top international magazines, Professor Zhang Zhuoli’s team has led the domestic innovation of musculoskeletal ultrasound, magnetic resonance, mini arthroscopy and other innovative technologies in rheumatism.
The application has promoted the development of rheumatology in China.
The Department of Rheumatology and Immunology, Peking University First Hospital has been nominated in the ranking of the best hospitals in Fudan University in China for seven consecutive years, and has entered the top 10 of the Chinese Academy of Medical Sciences' scientific and technological influence rankings for five consecutive years.
Has become one of the unique domestic rheumatology and immunology specialties.
In order to further promote the development of domestic rheumatism and immunology, Professor Zhang Zhuoli led the team to sponsor more than forty sessions of "Musculoskeletal Ultrasound Standardized Operation Training" and "New Imaging Technology in Rheumatology".
disease application training "," North Rheumatology hot Topics "and other exchanges classes, won the praise of domestic sources of paper Division of Rheumatology physician: first hospital of Peking University author: Peking University first hospital Division of Rheumatology team responsibility Edit: Fenghe Cassette
As one of the TARRA cohort's standard treatment series studies, this study mainly focuses on the hormone reduction in the treatment standard, and aims to provide real-world evidence for the formulation of hormone reduction strategies in RA.
Recently, the research team of Professor Zhang Zhuoli from the Department of Rheumatology and Immunology of Peking University First Hospital published an original work titled "Dynamical trajectory of glucocorticoids" in the top journal Annals of the Rheumatic Diseases ("Rheumatology Yearbook", IF=16.
102).
tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020" research paper.
It is reported that this study was independently completed by the Department of Rheumatology and Immunology of Peking University First Hospital as the sole research unit.
It revealed for the first time that under the background of traditional synthetic disease-improving anti-rheumatic drugs (csDMARDs) treatment, patients with rheumatoid arthritis (RA) reduced glucocorticoids.
Dynamic changes and clinical characteristics of the amount and discontinuation.
As the world's first real-world study of hormone reduction and arrest under the background treatment of csDMARD, the results of this study will provide important real-world evidence for the formulation of hormone reduction strategies in RA and the optimization of the clinical use of hormones.
Figure 1 The topic of the thesis glucocorticoids still play an important role in the treatment of RA due to their potent anti-inflammatory properties.
Many clinical studies have confirmed that glucocorticoids can not only quickly and effectively control inflammation and relieve patients' joint symptoms, but also have the effect of inhibiting the progress of bone destruction.
Therefore, the European Union against Rheumatism (EULAR) management guidelines recommend that the initial treatment of RA can be combined with glucocorticoids as a bridging treatment before the onset of csDMARD, especially for RA patients with moderate to high disease activity.
Figure 2 Source: Nat Rev Rheumatol.
2016 Feb;12(2):73-4.
However, long-term glucocorticoid therapy may increase the risk of serious infections, diabetes, osteoporosis and other adverse events, even at very low doses in the case of.
Therefore, the EULAR 2019 management guidelines emphasize that hormones in RA treatment should be reduced and stopped as soon as clinically feasible, and the ideal stop time is about 3 months.
However, the current hormone reduction and stopping strategies in RA still lack evidence-based evidence, which has also led to vast differences in the use of hormones in clinical practice.
Although the EULAR management guidelines recommend that csDMARD combined with hormones can be used as the first-line treatment for RA patients, there is currently no research report on the reduction and discontinuation of hormones and clinical features under the csDMARD combined with hormone therapy.
Figure 3 Source: Nat Rev Rheumatol.
2010 Dec;6(12):693-702.
In response to this key issue, Professor Zhang Zhuoli’s research team based on the ten-year real-world RA treatment in the Department of Rheumatology and Immunology of Peking University First Hospital The cohort (Treat-TARget in RA, TARRA cohort), for the first time, fully revealed the dynamic trajectory and clinical characteristics of the reduction and withdrawal of hormones in RA patients under the background of csDMARDs treatment.
After screening the 1432 RA patients in the TARRA cohort according to the predetermined inclusion and exclusion criteria, a total of 207 RA patients with initial hormone combined with csDMARD were enrolled.
The initial median prednisolone or equivalent dose of the enrolled patients was 10 (5-10) mg/d, which decreased to 7.
5 (5-10) mg/d at the third month and decreased to 7.
5 (5-10) mg/d at the 6th month 5.
0 (2.
5-10) mg/d, until the 48th month reduced to 0 (0-5.
0) mg/d. During a median follow-up of 38.
6 months, 59.
9% (124/207) of the patients stopped using hormones.
At the 6th month, 1, 2 years, and 3 years, the cumulative hormone withdrawal rates were 9.
7%, 26.
6%, 48.
0%, and 58.
6%, respectively, and the median hormone withdrawal time was 27 months (Figure 4).
Figure 4 Kaplan Meier survival curve of cumulative hormone discontinuation rate in RA patients during follow-up.
110 patients were newly treated patients.
In these patients, the cumulative hormone discontinuation rate was 12.
7% at the 6th month, 1st year, 2nd year and 3rd year, respectively.
, 30.
0%, 50.
9% and 60.
6%, the median time to stop the hormone is 24 months.
At the same time, an analysis of patients who visited before and after 2014 found that the median time to stop hormones in RA patients after 2014 was significantly shortened, and the withdrawal rate was significantly increased (20.
0 months vs.
36.
0 months; 64.
1% vs.
56.
5% , P=0.
002).
Among the patients who stopped using hormones, more than half of the patients were in clinical remission when the hormones were stopped, and more than two-thirds of the patients had no disease recurrence within 6 months after stopping the hormones.
As the world’s first real-world study of hormone reduction and arrest under the background treatment of csDMARD, the results of this study show that for RA patients receiving hormone combined with csDMARD treatment, when the disease activity is well controlled, rheumatologists can consider stopping the hormone, and Most patients did not experience short-term recurrence after stopping hormones; however, in clinical practice, the stopping time of hormones was much longer than the time recommended by the current guidelines, which suggests that there is still a certain gap between the reduction and stopping of hormones in clinical practice and management guidelines.
The important findings of the study will provide important evidence-based evidence for the formulation of hormone reduction strategies in RA and the optimization of the clinical use of hormones.
"Rheumatology Yearbook" was founded in 1939.
It is a sub-issue of the British Medical Journal (BMJ) and the official journal of EULAR.
It is also an original journal with the highest impact factor in rheumatology.
"Rheumatism Yearbook" covers all aspects of rheumatism, including musculoskeletal system diseases, arthritis diseases, connective tissue diseases, etc.
It publishes basic, clinical and translational scientific research, including authoritative management guidelines for various diseases. In Clarivate Analytics' latest 2019 journal citation report, the journal ranked second among 32 rheumatology journals, with an impact factor of 16.
102, JCR Q1 area.
The corresponding author of the paper is Professor Zhang Zhuoli from the Department of Rheumatology and Immunology, Peking University First Hospital, and the first author is doctoral student Xie Wenhui.
This research was funded by the National Natural Science Foundation of China.
It is reported that based on the TARRA cohort, Professor Zhang Zhuoli’s research team has carried out a series of original work on the treatment of RA standards and published them in internationally renowned journals, such as the benefits of the treatment of standards in the Chinese RA population (Clin Exp Rheumatol.
2018;36:820-828 ), continuous clinical remission rate and predictive factors (Int J Rheum Dis.
2019;22:1670-1678), early clinical remission rate and predictive factors (Clin Rheumatol.
2020;39:381-389), comorbidities for achieving standard treatment Impact (Arthritis Res Ther.
2020; 22: 100), the impact of standard treatment on the progress of imaging (Clin Rheumatol.
2021; 40: 1307-1315), and the first proposed low disease activity under the Boolean definition (Rheumatol Ther.
2020 Dec 23 )Wait.
As one of the TARRA cohort's standard treatment series studies, this study mainly focuses on hormone reduction in the treatment target, and aims to provide real-world evidence for the development of hormone reduction strategies in RA.
At the same time, the research team also prospectively established a clinical follow-up cohort for systemic lupus erythematosus, a clinical follow-up cohort for psoriatic arthritis, and an RA team collaborative intensive treatment cohort (CENTRA cohort).
Based on these cohorts, the research team is continuing to carry out and publish a series of high-level studies, such as the mortality and prognostic factors of the Chinese population with systemic lupus erythematosus (Lupus.
2018;27:1742-1752) and lupus compliance status and predictive factors (Rheumatology ( Oxford).
2020;59:3400-3407). The establishment of these prospective cohorts and the publication of high-level research papers reflect that the Department of Rheumatology and Immunology of Peking University First Hospital has a world-class clinical research platform and level.
In the future, the research team will definitely develop in the field of rheumatism.
Going further, keep moving forward without forgetting the original intention.
Reference materials: [1] https://ard.
bmj.
com/content/early/2021/04/01/annrheumdis-2021-220112 Expert profile Professor Zhang Zhuoli, chief physician, professor, and doctoral supervisor, is currently the Rheumatology Department of Peking University First Hospital Director of the Department of Immunology, Deputy Chairman and Secretary-General of the Chinese Medical Association Rheumatology Group Leader of the Rheumatology Branch of the Chinese Medical Doctor Association Leader of the Imaging Group of the Rheumatology Professional Committee of the Cross-Strait Medical and Health Exchange Association Deputy Chairman of the Rheumatology Branch of the Beijing Medical Association The leader of the rheumatism group of the National Medical Examination Center of the Health Commission has long been engaged in basic and clinical research on rheumatism and immunology, and has achieved a number of original and applied results, won a number of scientific research grants and awards, and published more than 300 papers, including Ann Rheum Dis, Lancet Rheumatol, Arthritis Rheumatol, Blood, Eur Respir J, J Am Acad Dermatol, Autoimmun Rev and other top international magazines, Professor Zhang Zhuoli’s team has led the domestic innovation of musculoskeletal ultrasound, magnetic resonance, mini arthroscopy and other innovative technologies in rheumatism.
The application has promoted the development of rheumatology in China.
The Department of Rheumatology and Immunology, Peking University First Hospital has been nominated in the ranking of the best hospitals in Fudan University in China for seven consecutive years, and has entered the top 10 of the Chinese Academy of Medical Sciences' scientific and technological influence rankings for five consecutive years.
Has become one of the unique domestic rheumatology and immunology specialties.
In order to further promote the development of domestic rheumatism and immunology, Professor Zhang Zhuoli led the team to sponsor more than forty sessions of "Musculoskeletal Ultrasound Standardized Operation Training" and "New Imaging Technology in Rheumatology".
disease application training "," North Rheumatology hot Topics "and other exchanges classes, won the praise of domestic sources of paper Division of Rheumatology physician: first hospital of Peking University author: Peking University first hospital Division of Rheumatology team responsibility Edit: Fenghe Cassette
