Objective Achieving targeted disease activity (DA) is the primary therapeutic strategy in RA. Point measurements of DA are done at out-patient visits, however true DA between visits remains unobserved. This study sought to describe and validate a new outcome measure, i.e. time in remission (TIR). Methods Patients were enrolled in the Czech ATTRA-RA registry. TIR was calculated using linear interpolation of the DAS28-ESR determined at outpatient visits. Correlation coefficients were computed between TIR and DAS28-CRP, HAQ, Simple Disease Activity Index (SDAI), patient global assessment (PGA) and physician global assessment (PhGA). Using logistic regression, TIR was used as a predictor of remission (SDAI ≤3.3) and non-disability (HAQ <0.5). The predictive value of TIR was compared with point and sustained remission using the cross-validated area under receiver-operating curves. Results Since 2010, 2618 RA patients started anti-TNF therapy and were followed until 2020 or until treatment discontinuation. During the first 6 months of therapy, 56% of patients had no remission (TIR = 0), and 22% of patients reached sustained remission (TIR = 1), while 22% of patients had point remissions with 0 < TIR < 1. EULAR good responders and moderate/non-responders spent 64 ± 42% and 6 ± 18% of time in remission, respectively. The mean TIR grew during the follow-up and was correlated with DAS28-CRP, SDAI, HAQ, PGA, and PhGA (P < 0.0001). TIR at 3 and 6 months predicted remission (SDAI ≤3.3) and non-disability (HAQ <0.5) at 13 and 19 months better than point or sustained remission. Conclusions TIR is an intuitive way of estimating unobserved DA between scheduled visits; its calculation only requires two consecutive DA values (https://www.medevio.cz/tir-calculator/). TIR is a valid predictor of RA outcomes.

中文翻译：

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缓解时间作为类风湿性关节炎的替代结果测量：一项针对 2618 名抗 TNF 新用户的 10 年前瞻性研究

目的实现靶向疾病活动（DA）是RA的主要治疗策略。DA 的点测量在门诊就诊时进行，但就诊之间的真实 DA 仍未观察到。本研究试图描述和验证一种新的结果测量方法，即缓解时间 (TIR)。方法 患者被纳入捷克 ATTRA-RA 登记处。使用在门诊就诊时确定的 DAS28-ESR 的线性插值计算 TIR。计算 TIR 与 DAS28-CRP、HAQ、简单疾病活动指数 (SDAI)、患者整体评估 (PGA) 和医师整体评估 (PhGA) 之间的相关系数。使用逻辑回归，TIR 被用作缓解 (SDAI ≤3.3) 和非残疾 (HAQ <0.5) 的预测因子。使用接受者操作曲线下的交叉验证区域将 TIR 的预测值与点和持续缓解进行比较。结果 自 2010 年以来，2618 名 RA 患者开始抗 TNF 治疗，并随访至 2020 年或治疗终止。在治疗的前 6 个月中，56% 的患者没有缓解（TIR = 0），22% 的患者达到持续缓解（TIR = 1），而 22% 的患者达到了点缓解，0 < TIR < 1. EULAR 良好反应者和中度/无反应者分别花费了 64 ± 42% 和 6 ± 18% 的缓解时间。平均 TIR 在随访期间增加，并与 DAS28-CRP、SDAI、HAQ、PGA 和 PhGA 相关（P < 0.0001）。3 个月和 6 个月的 TIR 预测缓解 (SDAI ≤3.3) 和非残疾 (HAQ <0. 5) 在 13 和 19 个月时好于点或持续缓解。结论 TIR 是一种直观的方式来估计预定访问之间未观察到的 DA；它的计算只需要两个连续的 DA 值 (https://www.medevio.cz/tir-calculator/)。TIR 是 RA 结果的有效预测指标。