电子辅助的个体化严密控制策略比常规方法更有效地帮助早期RA实现全面控制病情

THU0122

A TAILORED TELEMONITORING TIGHT CONTROL STRATEGY FOR PATIENTS WITH EARLY RHEUMATOID ARTHRITIS. IS MORE EFFECTIVE THAN USUAL CARE TREATMENT IN DAILY CLINICAL PRACTICE?

F. Salaffi1,*, M. Carotti2, A. Ciapetti1, M. Di
Carlo1, M. Gutierrez1

1Rheumatology Departement, 2Radiology
Departement, Polytecnic University of the Marche, Jesi,
Italy

Objectives: To
investigate whether an intensive treatment strategy in early
rheumatoid arthritis (ERA), by an internet-based home tailored
telemonitoring tight control (TTTC) protocol is more effective than
treatment according to usual care in reaching remission and
comprehensive disease control (CDC) after 1 year [1, 2].
Additionally we evaluated the patients’ satisfaction with the
technological device.

目的: 本研究拟探讨采用基于互联网、个体化、严密控制病情的范式(TTTC)对早期RA(ERA)进行强化治疗1年，是否在获得临床缓解和全面控制病情(CDC)方面优于传统治疗模式。此外，我们还将评估患者对技术设备的满意度。

Methods: Two
ERA cohorts were compared. In the TTTC cohort (n=21), a regular
evaluation guided by a remote approach of disease activity was
applied, according to a CDAI-driven step-up treatment strategy.
Patients in the usual-care cohort (n=20) were treated without a
CDAI-guided strategy, so treatment decision were made according to
the discretion of the rheumatologist. Primary outcome measures were
the proportion of patients in remission (CDAI <2.8) and the
achievement of comprehensive disease control (CDC). Secondary
endpoints were the 1-year area under the curve (AUC) of CDAI minor,
moderate and major response cutpoints. Further we reported the
results in terms on patients' satisfaction with the technological
device.

方法: 对两个ERA队列进行比较。对于TTTC队列(n=21)，根据CDAI驱动升阶治疗策略，定期进行远程引导的疾病活动度评估。常规治疗队列(n=20)治疗决策无需参考CDAI，治疗决策全凭风湿病医生的个人经验。主要观察终点为达到临床缓解(CDAI<2.8)、CDC的患者比例。次要终点为分别对应于CDAI轻度、中度和显著应答界值的1年期CDAI曲线下面积(AUC)。分析患者对技术设备的满意度。

Results: A
higher percentage of patients in the TTTC group achieved CDAI
remission versus patients in usual care (38.1% vs 25% at year 1,
p<0.01). Time to achieve remission (CDAI<2.8) was
significantly shorter in the TTTC group than in the usual-care
group, with a median of 20 weeks versus a median over 36 weeks
(p<0.001). Concordantly, the patients followed for one year in
tight control showed a greater improvement (p <0.001) compared
with the usual care group in terms of clinical activity (38.1% vs.
25%), functional impairment (71.4% vs. 35%) and radiological damage
progression (23.8% vs. 10%), resulting in a greater rate of CDC
(19.4% vs. 5%). Moreover was found high satisfaction among the vast
majority of respondents.

结果:  随访1年的结果显示，相较于常规治疗队列，TTTC队列达到CDAI缓解的患者比例更高(38.1％vs
25％，P
<0.01)。TTTC队列达到缓解(CDAI<2.8)的疗程显著短于常规治疗组（20周 vs 超过36周，p
<0.001)。与此相应，在1年随访期间，严密控制病情组相较常规治疗组在诸多方面有更大的改善(p值均小于0.001)，包括临床活动度(38.1％ vs
25％)、功能障碍(71.4％ vs
35％)和放射损伤进展(23.8％ vs
10％)，从而实现更高比例的CDC
(19.4％ vs
5％)。此外，绝大多数参试者者对所用设备表示满意。

Conclusions: This
preliminary study demonstrates that an intensive internet-based
home TTTC is more effective in reaching remission and CDC than the
usual care. Moreover it is higly accepted by the patients. Larger
studies with rigorous designs are needed to get better evidence on
the effects of telemedicine interventions on health, satisfaction
with care and costs.

结论: 这项初步研究表明，与常规诊疗相比，基于互联网的严密监控、强化治疗策略能有效地实现临床缓解和全面控制病情。而且，患者高度接受该设备。因此，需要有更多严谨设计的研究以更好地证实远程医疗干预对健康、病人满意度和医疗费用的影响。

References:

1.    
Schipper LG, Vermeer M, Kuper HH, et al. A tight control
treatment strategy aiming for remission in early rheumatoid
arthritis is more effective than usual care treatment in daily
clinical practice: a study of two cohorts in the Dutch Rheumatoid
Arthritis Monitoring registry. Ann Rheum Dis 2012; 71(6):
845-50.

2.    
Emery P, Kavanaugh A, Bao Y, et al. Comprehensive disease
control (CDC): wath does achieving CDC mean for patients with
rheumatoid arthritis? Ann Rheum Dis 2014; 205302 [Epub ahead of
print].