Rheumatoid arthritis: clinical features
Notice bibliographique
Résumé
Background: NICE guidelines recommend that patients with severe active RA be treated with a biologic disease-modifying anti-rheumatic drug as monotherapy (bDMARD mono) if they respond inadequately to 2 traditional DMARDs and are intolerant to MTX.Registry and healthcare utilization data have shown that around one-third of RA patients receive their biologic treatment as monotherapy.Methods: This UK wide chart review was undertaken to better understand the current management of RA patients with biologics in monotherapy, in particular, why patients receive monotherapy and how effective this is in daily practice.The chart review was conducted across 26 rheumatology departments between September 2012 and May 2013 and data from 309 RA patients, who had been prescribed a bDMARD mono, were collected retrospectively.Data are presented from an interim analysis of 150 patients.Results: The mean patient age was 62.4 years and mean duration of disease was 16.3 years.The majority of patients were female (109).102 (74.4%) patients were RF positive (n ¼ 137) and 34 (36.6%)anticyclic citrullinated peptide (anti-CCP) antibody positive (n ¼ 93).With regards to past RA treatment (prior to switch to monotherapy, n ¼ 61), the most frequently used bDMARDs monotherapies (at any time prior to switch) were etanercept (ETN; 19.3%), adalimumab (ADA; 14%), certolizumab pegol (CZP, 7.3%), rituximab (RTX, 4.7%) and tocilizumab (TCZ, 2.7%).55 (36.7%) patients had used two or more bDMARD monotherapies.The most frequently used traditional DMARDs (n ¼ 146) were MTX (92%), SSZ (74.7%) and HCQ (42.7%).With regards to current RA treatment (all patients receiving bDMARD mono), the most frequently used bDMARDs were ETN (42.7%),ADA (26%), TCZ (10.7%),RTX (9.3%) and CZP (8%).The main reason for prescribing bDMARD monotherapy (n ¼ 150) was unknown (88%, assumed clinician decision), with other stated reasons including patient preference (6.7%) and contra-indications (7.3%).Nearly a quarter of patients were taking a non-NICE approved monotherapy drug and only 24.2% were in DAS28 ESR remission.Conclusion: Registry and healthcare utilization data have shown that around one-third of RA patients receive their biologic treatment as monotherapy.The results of this audit highlight a patient population where treatment outcomes with bDMARD monotherapy are still not optimal (only 24.2% were in DAS28 ESR remission).76.7% of the patients were treated with NICE approved TNF inhibitors, and 55 (36.7%) patients had used two or more bDMARD monotherapies, indicating that there are a significant number of patients where combination therapy with traditional DMARDs is not an option.As remission is the treatment goal and only 24.2% of patients were in remission, there appears to be an unmet medical need.Alternative treatment options should be explored to ensure better treatment outcomes for patients with this debilitating disease.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,017 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».