Icariin may be a potential drug targeting epigenetic changes for the treatment of steroid-associated ONFH.
BackgroundIn real-world clinical practice, self-paid and expensive price limit the application of bDMARDs and only a few patients especially in developing countries could afford long-term use. Only 9.1%>11% of Chinese rheumatoid arthritis (RA) patients were treated with bDMARDs with mean course no more than 6 months. Such short course of bDMARDs had always been raised doubt about their efficacy and benefit for rare reported evidence.ObjectivesTo explore the efficacy of additional short-course of Tocilizumab (TCZ) combined with csDMARDs in real-world RA management.MethodsConsecutive patients with active RA (DAS28-ESR>2.6) who had completed 6 month follow-up were retrospectively recruited from a prospective RA cohort (n=582). All patients were treated according to the treat-to-target strategy and patient’s willingness especially biologics use. RA patients who finished at least 3 infusions of TCZ (8 mg/Kg/4 weeks) were included as add-on TCZ group, and matched RA patients without any bDMARDs by age, sex and disease activity at baseline with the ratio of 1:1 were included as csDMARDs group. Clinical data were collected according to the 2017 EULAR recommendation at baseline and regular visits at week 4, 12 and 24.Results(1) The baseline characteristics of 101 paired RA patients showed no significant difference except for lower csDMARDs-naïve percentage between two groups (table 1). (2) During 24 week follow up, there were significantly higher percentage of patients in add-on TCZ group achieving therapeutic target (DAS28-ESR<3.2, at Week 4: 59% vs. 39%, p=0.005; at Week 12: 71% vs. 52%, p=0.006, figure 1) or remission (DAS28-ESR<2.6, at Week 4: 46% vs. 16%, p<0.001; at Week 12: 53% vs. 28%, p<0.001) than those in csDMARDs group. Furthermore, there were significantly higher percentage of patients in add-on TCZ group achieving deep remission (DAS28-ESR≤1.98, at Week 4: 16% vs. 5%, p=0.015; at Week 12: 28% vs. 9%, p=0.001; at Week 24: 20% vs. 9%, p=0.046). (3) There were 76% RA patients in add-on TCZ group with glucocorticoids (GC) therapy which is significantly lower than that in csDMARDs group (92%, p=0.002). Among patients with GC therapy, the GC dosage per day was tapered more rapidly at each visit and the cumulative dose at week 24 was significantly lower in add-on TCZ group than that in csDMARDs group (826±616 vs. 1128±519 mg, p<0.001).Table 1Baseline characteristics of RA patients in add-on TCZ group or csDMARDs groupConclusionsAdd-on short-course TCZ may be an alternative induction strategy for RA patients in developing countries which can quickly achieve target and accelerate dose tapering of GC.AcknowledgementsThis work was supported by National Natural Science Foundation of China (grant no. 81471597, 81671612 and 8160147) and Guangdong Natural Science Foundation (grant no. 2016A030313307 and 2017A030313576).Disclosure of InterestNone declaredAbstract THU0206 – Figure 1Dynamic changes of therapy indexes between add-on TCZ group and csDMARDs group. (A-H) Comparison of disease activity indexes at baseline and week ...
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