Abstract:
OBJECTIVE:This study was designed to compare outcomes of dose reduction, withdrawal, and continuation of tofacitinib in patients with rheumatoid arthritis (RA) and to examine effectiveness of rescue with an original treatment regimen for disease flare. METHODS:We prospectively enrolled 100 patients who had high or moderate disease activity and treated them with tofacitinib at 5 mg twice daily for 1 year. All patients achieving remission or low disease activity (LDA) were assigned to a withdrawal, dose-reduction, or continuation group, then followed until disease flare or end of the study. For flare cases, the original treatment regimen was reintroduced. RESULTS:During the first year, 68 patients achieved remission or LDA (median sustained time 49.0 weeks). Subsequently, disease flare occurred at the following crude incidence rates per person-year (95% confidence interval [CI]): 0.73 (0.43-1.22) after withdrawal, 0.44 (0.25-0.77) after dose reduction, and 0.04 (0.01-0.27) during continuation. Kaplan-Meier estimates of median flare-free time (95% CI) were 7.0 months (2.8-11.2) for withdrawal and 21.0 months (4.1-37.9) for dose reduction. In the Cox regression analysis, adjusted hazard ratios (95% CIs) were 18.11 (2.38-138) for withdrawal and 9.13 (1.19-70.4) for dose reduction compared with continuation. Restart of the original treatment regimen led to rapid remission in flare cases (93% for withdrawal and 100% for dose reduction). CONCLUSION:After achievement of remission or LDA, the dose-reduction strategy seems preferable to immediate withdrawal of tofacitinib. Restart of the original regimen can reinduce RA control in flare cases.Key Points• During the 1-year tofacitinib therapy, two-thirds of RA patients with high or moderate disease activity achieved rapid and sustained remission or low disease activity.• During subsequent years, the incidence rate and adjusted hazard ratio for disease flare were significantly higher following tofacitinib immediate withdrawal than following dose reduction.• Half of the patients were estimated to remain flare-free for 21 months after dose reduction and for 7 months after withdrawal of tofacitinib.• Restart of the original treatment regimen rapidly restored disease control in almost all flare cases.
journal_name
Clin Rheumatoljournal_title
Clinical rheumatologyauthors
Mori S,Ueki Ydoi
10.1007/s10067-019-04721-zsubject
Has Abstractpub_date
2019-12-01 00:00:00pages
3391-3400issue
12eissn
0770-3198issn
1434-9949pii
10.1007/s10067-019-04721-zjournal_volume
38pub_type
杂志文章abstract::Rheumatoid arthritis (RA) is well known to affect many different organ systems. Previous work suggests that this includes the auditory system and that measures of hearing may be related to indices of RA disease activity. The aims of this study were to determine whether hearing loss in young subjects with rheumatoid ar...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-007-0802-z
更新日期:2008-05-01 00:00:00
abstract::Susceptibility to systemic lupus erythematosus (SLE) is associated with genetic, hormonal, immunological, and environmental factors. Many genes have been related with the appearance of SLE, including several loci that code different complement components and their receptors. Some genetic deficiencies of complement mol...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s10067-008-0838-8
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abstract::In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskelet...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s10067-006-0433-9
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To determine incidence of increased levels of alanine transferase (ALT) >2× upper limit of normal (ULN) in patients receiving methotrexate (MTX), treated according to a dynamic strategy, and to identify predictors of ALT of >2× ULN. METHODS:Data of 508 recent-onset rheumatoid arthritis (RA) patients from the...
journal_title:Clinical rheumatology
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10067-012-2136-8
更新日期:2013-05-01 00:00:00
abstract::The aim of this study was to evaluate clinical remission and MDA in PsA patients who started TNF-inhibitors (TNFi) treatment with a 2-year follow-up. Concomitant therapies as well as comorbidities were assessed. Level of concordance of clinimetric indices and the potential predictive factors of remission/MDA were also...
journal_title:Clinical rheumatology
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更新日期:2017-10-01 00:00:00
abstract::While fibromyalgia is frequently associated with ear-related symptoms such as feeling of ear fullness, earache, and tinnitus, the pathogenesis of these ear-related symptoms in fibromyalgia patients is unknown. Here, we focused on clarifying the pathogenesis of ear fullness, a particularly common symptom observed in fi...
journal_title:Clinical rheumatology
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doi:10.1007/s10067-013-2287-2
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abstract::Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of Sp...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s100670050011
更新日期:2000-01-01 00:00:00
abstract::Joint lavage for knee osteoarthritis is an invasive procedure that can be stressful and painful. We aimed to assess the impact of music therapy on perioperative anxiety, pain and tolerability of the procedure in patients undergoing joint lavage performed with two needles. We randomized all patients diagnosed with knee...
journal_title:Clinical rheumatology
pub_type: 杂志文章,随机对照试验
doi:10.1007/s10067-011-1925-9
更新日期:2012-03-01 00:00:00
abstract::Increased IFN-γ levels have been associated with systemic lupus erythematosus (SLE). However, the relationships among IFN-γ, type I interferons (IFNs) and clinical features have not been extensively studied. Peripheral blood samples from 44 SLE patients and 36 healthy donors (HDs) were collected. Quantitative real-tim...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-018-4138-7
更新日期:2018-10-01 00:00:00
abstract::Bone loss in patients with rheumatoid arthritis (RA) varies at different skeletal sites. The aim of the study was to evaluate whether bone mineral density (BMD) of the forearm is significantly different in patients with RA and controls and may correlate to BMD or other parameters of inflammation or bone resorption. We...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-009-1211-2
更新日期:2009-10-01 00:00:00
abstract::The clinical response to traditional disease-modifying anti-rheumatic drugs (DMARDs) in indigent South Africans with early rheumatoid arthritis was investigated. A cohort of patients with early (≤2 years) RA who were DMARD-naïve at inception were prospectively assessed for response to DMARDs using the Simplified Disea...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-011-1900-5
更新日期:2012-04-01 00:00:00
abstract::Muscle pain and weakness in a rheumatoid arthritis (RA) patient has a broad differential, and myositis should be considered early in the disease course as serious limb and life-threatening sequelae may occur. A 55-year-old woman with a past medical history of methotrexate-controlled RA presented with right leg pain fo...
journal_title:Clinical rheumatology
pub_type: 杂志文章,评审
doi:10.1007/s10067-014-2657-4
更新日期:2015-10-01 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02208347
更新日期:1995-05-01 00:00:00
abstract::B cells in patients with rheumatoid arthritis (RA) are hyperactivated. Although B cell receptor signal transduction may be affected by various response regulators, CD22 plays an important role as a response regulator of B cells. Therefore, we investigated and examined CD22 expression on peripheral blood B cells of pat...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-007-0665-3
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:Adult-onset Still's disease (AOSD) is an autoinflammatory disorder leading to multiorgan involvements. We sought to investigate mood status and the health-related quality of life (HRQoL) in these patients. METHODS:In this study, 82 AOSD patients and 82 age- and sex-matched healthy controls were included. Dem...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-020-05094-4
更新日期:2020-12-01 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-020-05228-8
更新日期:2020-07-21 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-020-05441-5
更新日期:2020-10-10 00:00:00
abstract::Ochronosis involves primarily the large cartilaginous joint surfaces, ribs, intervertebral discs, ear cartilage etc. We report on a 53-year-old woman with typical alkaptonuric ochronosis with dark urine, blue-black pigmentation of the auriculae and hands, focal brown hyperpigmentation of the sclera, spondylarthropathy...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-002-8277-4
更新日期:2002-05-01 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
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更新日期:2018-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s10067-015-2922-1
更新日期:2015-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/s10067-011-1730-5
更新日期:2011-09-01 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-010-1581-5
更新日期:2011-01-01 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-014-2539-9
更新日期:2014-11-01 00:00:00
abstract::CD30/CD30L and CD40/CD40L are molecules from the tumor necrosis factor (TNF) superfamily. They have a major effect on communications between the B and T cells, which leads to control of maturation, proliferation, and apoptosis of those cells. The aim of this study was to compare the levels of a soluble form of CD30 (s...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-006-0389-9
更新日期:2007-05-01 00:00:00
abstract::The aim of our study was to explore the relationship between circulating T cells and ankylosing spondylitis (AS) and to find the role of the CD8+CD122+ T cells in the pathogenesis and progression of AS. With the method of case-control design, flow cytometry was performed to quantitatively determine the percentage of c...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-017-3887-z
更新日期:2018-03-01 00:00:00
abstract::Gastrointestinal tract (GIT) is the most common organ system involved in systemic sclerosis (SSc). GIT involvement is mainly attributed to GIT dismobility and wide mouth diverticular. GIT involvement in SSc can be also severely debilitating and even life threatening. To our knowledge, the presence of gastrointestinal ...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-006-0264-8
更新日期:2007-06-01 00:00:00
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journal_title:Clinical rheumatology
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更新日期:2007-08-01 00:00:00
abstract::In an open study, we have assessed the bone/soft tissue uptake index in recent osteoporotic vertebral collapse using scintigraphy. The evolution of these cases was followed-up at 6 months in 22 patients treated with 100 IU of salmon calcitonin plus 500 mg of elemental calcium/10 days per month and in 18 patients treat...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/BF02208694
更新日期:1991-09-01 00:00:00
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journal_title:Clinical rheumatology
pub_type: 杂志文章
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更新日期:2006-05-01 00:00:00
abstract::Cytokine gene loci are one of the potential susceptibility factors in immuno-inflammatory diseases. Interleukin1 (IL-1) is a major monocyte derived proinflammatory cytokine that mediates tissue damage and cartilage loss in chronic arthritis. IL-1 locus has been linked to various autoimmune diseases, but data on juveni...
journal_title:Clinical rheumatology
pub_type: 杂志文章
doi:10.1007/s10067-011-1898-8
更新日期:2012-04-01 00:00:00