References

rsp

Научно-практическая ревматология

Rheumatology Science and Practice

1995-44841995-4492

IMA-PRESS, LLC

rsp-2306

Research Article

ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ

ORIGINAL RESEARCH

Стратегия «Лечение до достижения цели» при раннем псориатическом артрите (предварительные результаты исследования РЕМАРКА)

TREAT-TO-TARGET STRATEGY FOR EARLY PSORIATIC ARTHRITIS (PRELIMINARY RESULTS OF THE REMARCА STUDY)

Коротаева

Т. В.

Korotaeva

T. V.

tatianakorotaeva@gmail.com

Логинова

Е. Ю.

Loginova

E. Yu.

face@neicon.ru

Каратеев

Д. Е.

Karateev

D. E.

face@neicon.ru

Глазков

А. А.

Glazkov

A. A.

face@neicon.ru

Насонов

Е. Л.

Nasonov

E. L.

face@neicon.ru

ФГБНУ Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation

ГБОУ ВПО «Московский государственный университет им. М.В. Ломоносова»РоссияM.V. Lomonosov Moscow State UniversityRussian Federation

2016

09122016

540

приложение 2

7175

2016

Коротаева Т.В., Логинова Е.Ю., Каратеев Д.Е., Глазков А.А., Насонов Е.Л.

Korotaeva T.V., Loginova E.Y., Karateev D.E., Glazkov A.A., Nasonov E.L.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://rsp.mediar-press.net/rsp/article/view/2306

Цель стратегии Т2Т (лечение до достижения цели) – достижение ремиссии или минимальной активности болезни (МАБ). Цель – изучить эффективность стратегии Т2Т при раннем псориатическом артрите (рПсА).Материал и методы. Обследовано 23 пациента с рПсА (8 мужчин и 15 женщин), соответствующих критериям CASPAR, средний возраст 39,1±10,6 года, медиана длительности ПсА 7 [4; 24] мес, псориаза – 36 [12; 84] мес. На момент включения и затем каждые 3 мес оценивали активность ПсА по DAS, DAS28, псориаза – по BSA(%) и PASI, определяли СОЭ (мм/ч) и уровень С-реактивного белка (СРБ, мг/л), HAQ. Всем назначалась монотерапия (МоТ) метотрексатом (МТ; методжект) подкожно в дозе 10 мг/нед с повышением дозы на 5 мг каждые 2 нед до достижения 20–25 мг/нед. Оценивали количество больных, достигших ремиссии (DAS <1,6 или DAS28 ≤2,4), низкой активности болезни (НАБ; 1,6≤DAS<2,4 или 2,4<DAS28≤3,6), МАБ, 20%, 50%, 70% улучшение по критериям Американской коллегии ревматологов (ACR). При отсутствии НАБ/МАБ или ремиссии через 3 мес назначали комбинированную терапию (КоТ): МТ+адалимумаб (АДА) 40 мг раз в 2 нед.Результаты. Исходно медиана DAS 3,97 [3,07; 4,67], DAS28 составлял 4,33 [3,68; 4,73], PASI 6 [3,1; 9,7], BSA 1 [0,5; 3,65], CРБ 15 [8,6; 25,1] мг/л, СОЭ 15 [8,6; 25,1] мм/ч, HAQ 0,75 [0,63; 1,25]. Через 3 мес МоТ МТ ремиссия по DAS/DAS28 была у 13/22,7%, НАБ – у 21,7/27,3%, МАБ – у 26,1% больных соответственно. 20%, 50%и 70% ответ по критериям ACR получен у 65,2; 26,15 и 8,7% больных соответственно. Значимо уменьшились уровень CPБ (до 5,7 [2,3; 10,7] мг/л), HAQ (0,38 [0; 0,87]), BSA (1 [0,3; 2]), PASI (7,1 [0; 32,5]). СОЭ существен-но не изменилась – 18 [10; 26] мл/ч. Четырем пациентам с сохраняющейся высокой активностью заболевания была назначена КоТ, 19 продолжали МоТ МТ. Через 6 мес ремиссия по DAS/DAS28 была у 34,8/39,1%, НАБ по DAS/DAS28 – у 26,1/39,1% и МАБ – у 47,8% больных соответственно. 20%, 50% и 70% улучшения по критериям ACR достигли 73,9; 60,9 и 47,8% больных соответственно. Значимо уменьшился уровень CРБ (4,9 [0,9; 8,3]), HAQ (0,13 [0; 0,63]) и BSA (0,35 [0; 1,6]). На МоТ МТ (n=19) ремиссия по DAS/DAS28 была у 36,8/36,8%, НАБ – у 15,8/36,8%, МАБ достигли 47,4% больных. 20%, 50% и 70% ответ по критериям ACR на МоТ МТ получен у 68,4/52,6/42,1%, на КоТ (n=4) у 100/100/75% больных соответственно, МАБ отмечалась в 50% случаев.Выводы. Использование стратегии Т2Т позволило за 6 мес получить 70% ответ по критериям ACR и добиться МАБ у половины больных и обеспечивало ремиссию у 1/3 больных рПсА.

The aim of a treat-to-target (T2T) strategy is to achieve a remission or minimal disease activity (MDA).Objective: to investigate the efficiency of the T2T strategy for early psoriatic arthritis (ePsA). Subjects and methods. Twenty-three patients (8 men and 15 women) with ePsA, who met the CASPAR criteria (mean age was 39.1±10.6 years; the median duration of ePsA was 7 [4; 24] months and that of psoriasis was 36 [12; 84] months), were examined. At the patient inclusion and then every 3 months, the investigators assessed the activity of ePsA by DAS and DAS28 and that of psoriasis by BSA (%) and PASI and determined erythrocyte sedimentation rate (ESR) (mm/h), C-reactive protein (CRP) level (mg/l), HAQ. All the patients received monotherapy (MoT) with subcutaneous methotrexate (MTX) (methoject) in a dose of 10 mg/week that was increased by 5 mg every 2 weeks until 20–25 mg/week was reached. The number of patients who had achieved remission (DAS <1.6 or DAS28 ≤ 2.4), low disease activity (LDA) (1.6 ≤ DAS <2.4 or 2.4 < DAS28 ≤ 3.6), MDA, and 20%, 50%, and 70% improvements according to the American College of Rheumatology (ACR) criteria. When LDA/MDA or remission was absent at 3 months of treatment, combined therapy (CoT) with MTX and adalimumab 40 mg once two weeks was used.Results. The baseline median DAS was 3.97 [3.07; 4.67]; DAS28 – 4.33 [3.68; 4.73], PASI, 6 [3.1; 9.7]; BSA, 1 [0.5; 3.65]; CRP, 15 [8.6; 25.1] mg/l; ESR, 15 [8.6; 25.1] mm/h; and HAQ, 0.75 [0.63; 1.25]. After 3 months of MoT, remission defined by DAS and DAS28 was in 13/22.7% of the patients; LDA in 21.7/27.3%, and MDA in 26.1%,respectively. ACR 20, 50, and 70 responses were obtained in 65.2, 26.15, and 8.7% of the patients, respectively. There were significant decreases in the level of CRP (to 5.7 [2.3; 10.7] mg/l), HAQ (0.38 [0; 0.87]), BSA (1 [0.3; 2]), and PASI (7.1 [0; 32.5]). ESR remained substantially unchanged (18 [10; 26] ml/h). Four patients with persistent high disease activity were given CoT; 19 patients continued MTX MoT. After 6 months, DAS/DAS28 remission was in 34.8/39.1% of the patients; DAS/DAS28 LDA in 26.1/39.1%; and MDA in 47.8%, respectively. ACR 20, 50, and 70% improvements were seen in 73.9, 60.9, and 47.8% of the patients, respectively. There were significant reductions in the level of CRP (4.9 [0.9; 8.3]), HAQ (0.13 [0; 0.63]), and BSA (0.35 [0; 1.6]). After MTX MoT, DAS/DAS28 remission was observed in 36.8/36.8% of the 19 patients; LDA in 15.8/36.8%; and MDA in 47.4%. ACR 20, 50, and 70 responseswere seen in 68.4, 52.6, and 42.1% of the patients receiving MTX MoT and in 100, 100, 75% of the patients (n = 4) having CoT, respectively; MDA was noted in 50% of the cases.Conclusion. The use of the T2T strategy during a 6-month period could provide ACR 70 response and MDA in half of the patients and remission in one third of the patients with ePsA.

ранний псориатический артритстратегия Т2Т

early psoriatic arthritistreat-to-target strategy

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The authors declare that there are no conflicts of interest present.