Efficacy,safety,and cost-effectiveness of triple therapy in preventing relapse in rheumatoid arthritis:A randomized controlled trial(ESCoRT study)

作     者：Juan Zhao Wei Zhou Yangfeng Wu Xiaoyan Yan Li Yang Zhuoli Zhang Juan Zhao;Wei Zhou;Yangfeng Wu;Xiaoyan Yan;Li Yang;Zhuoli Zhang

作者机构：Department of Rheumatology and Clinical ImmunologyPeking University First HospitalBeijing 100034China Peking University Clinical Research Institute(PUCRI)Beijing 100083China Peking University School of Public HealthBeijing 100083China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2022年第135卷第18期

页      面：2200-2209页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：supported by a grant from Peking University Clinical Research Program(No.PUCRP201305) 

主　　题：Conventional synthetic disease-modifying anti-rheumatic drugs Cost-effectiveness Relapse Rheumatoid arthritis Tumor necrosis factor inhibitors 

摘      要：Background:Biological agents,such as tumor necrosis factor inhibitors(TNFi),have been widely used in rheumatoid arthritis(RA)patients and greatly improved goal *** aim of this study was to investigate whether conventional synthetic diseasemodifying anti-rheumatic drugs(csDMARDs)combination was better in reducing relapse than methotrexate(MTX)monotherapy,and more cost-effective than continuing TNFi plus MTX in RA patients who achieved low disease activity(LDA)with TNFi and MTX ***:RA patients who failed to csDMARDs received an induction therapy of MTX plus TNFi for maximally 12 *** achieving LDA in 12 weeks were randomly assigned at a 1:1:1 ratio into three groups:(A)adding hydroxychloroquine and sulfasalazine for the first 12 weeks and then discontinuing TNFi for the following 48 weeks;(B)maintaining TNFi and MTX for 60 weeks;and(C)maintaining TNFi and MTX for the first 12 weeks and then discontinuing TNFi for the following 48 *** primary outcome was ***:A total of 117 patients were enrolled for induction therapy and 67 patients who achieved LDA within 12 weeks were randomized,with 24,21,and 22 patients in groups A,B,and C,*** relapse rates of groups A and B during the entire 60 weeks were comparable[10/22(45.5%)vs.7/20(35.0%),χ^(2)=0.475,P=0.491],however,significantly lower than that of group C[10/22(45.5%)vs.17/20(85.0%),χ^(2)=5.517,P=0.019;7/20(35.0%)vs.17/20(85.0%),χ^(2)=11.035,P=0.004,respectively].Taking RMB 100,000 Yuan as the threshold of willingness to pay,compared to MTX monotherapy(group C),both TNFi maintenance and triple csDMARDs therapies were cost-effective,but triple csDMARDs therapy was ***:For RA patients who have achieved LDA with TNFi and MTX,csDMARDs triple therapy was a cost-effective option in favor of reducing *** registration:***,NCT02320630.