RMD open · 2026
Sustaining remission in rheumatoid arthritis: the role of clinical deep remission and its implications for drug tapering.
СтатьяНазвание и аннотация: Перевод в очереди
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Li Haihui, Zhou Mengyan, Zhu Huaqun, Li Chun, Guo Jianping, Jia Yuan, Li Ru
Аннотация
OBJECTIVE: While sustained remission is the treatment goal for rheumatoid arthritis (RA), its long-term remission remains challenging. This real-world study aimed to assess the role of clinical deep remission (CliDR) in sustained remission and the risk of relapse, as well as its interaction with drug tapering.
METHODS: Of the 541 patients enrolled in the cohort, 145 who achieved a Disease Activity Score in 28 joints using C reactive protein (CRP) remission with 5 years of follow-up after remission were included in this study. Participants were stratified by CliDR status (defined as no tender/swollen joints with normal CRP/erythrocyte sedimentation rate). Kaplan-Meier analysis was used to compare sustained remission rates. Multivariable Cox regression with time-dependent covariates was performed to identify independent predictors and to assess the interaction between CliDR and drug tapering.
RESULTS: The sustained remission rate declined over time but was significantly higher in the CliDR group (62.5%; 95% CI 45.3% to 77.1%) than the non-CliDR group (38.1%; 95% CI 29.6% to 47.3%) at 5 years (p=0.014). In the non-CliDR group, tapering was associated with an 8.47-fold increase in the hazard of relapse (HR=8.47, 95% CI 5.01 to 14.32, p<0.001). The interaction between group and tapering was statistically significant (HR=0.26, 95% CI 0.07 to 0.98, p=0.046), indicating that the effect of tapering on relapse risk was significantly attenuated in the CliDR group compared with the non-CliDR group.
CONCLUSIONS: Our findings suggest that achieving CliDR is associated with significantly higher sustained remission rates in RA and that the safety of treatment tapering is contingent on prior achievement of CliDR.
METHODS: Of the 541 patients enrolled in the cohort, 145 who achieved a Disease Activity Score in 28 joints using C reactive protein (CRP) remission with 5 years of follow-up after remission were included in this study. Participants were stratified by CliDR status (defined as no tender/swollen joints with normal CRP/erythrocyte sedimentation rate). Kaplan-Meier analysis was used to compare sustained remission rates. Multivariable Cox regression with time-dependent covariates was performed to identify independent predictors and to assess the interaction between CliDR and drug tapering.
RESULTS: The sustained remission rate declined over time but was significantly higher in the CliDR group (62.5%; 95% CI 45.3% to 77.1%) than the non-CliDR group (38.1%; 95% CI 29.6% to 47.3%) at 5 years (p=0.014). In the non-CliDR group, tapering was associated with an 8.47-fold increase in the hazard of relapse (HR=8.47, 95% CI 5.01 to 14.32, p<0.001). The interaction between group and tapering was statistically significant (HR=0.26, 95% CI 0.07 to 0.98, p=0.046), indicating that the effect of tapering on relapse risk was significantly attenuated in the CliDR group compared with the non-CliDR group.
CONCLUSIONS: Our findings suggest that achieving CliDR is associated with significantly higher sustained remission rates in RA and that the safety of treatment tapering is contingent on prior achievement of CliDR.