Medication adherence is suboptimal in rheumatoid arthritis (RA) patients and impacts outcomes. DMARD-free remission (DFR) is a sustainable and achievable outcome in a minority of RA patients. Different factors have been associated with DFR, although persistence in therapy (PT), a component of the adherence construct, has never been examined. The study’s primary aim was to investigate the impact of PT’s characteristics on DFR in a cohort of Hispanic patients with recent-onset RA. A single data abstractor reviewed the charts from 209 early (symptoms duration ≤ 1 year) RA patients. All the patients had prospective assessments of disease activity and PT and at least 1 year of follow-up, which was required for the DFR definition. DFR was defined when patients achieved ≥ 1 year of continuous Disease Activity Score-28 joints evaluated ≤ 2.6, without DMARDs and corticosteroids. PT was defined based on pre-specified criteria and recorded through an interview from 2004 to 2008 and thereafter through a questionnaire. Cases (patients who achieved ≥ 1 DFR status) were paired with controls (patients who never achieved DFR during their entire follow-up) according to ten relevant variables (1:2). Cox regression analysis estimated hazard ratios (HRs) for DFR according to two characteristics of PT: the % of the patient follow-up PT and early PT (first 2 years of patients’ follow-up). In March 2022, the population had 112 (55–181) patient/years follow-up. There were 23 patients (11%) with DFR after 74 months (44–122) of follow-up, and the DFR status was maintained during 48 months (18–82). Early PT was associated with DFR, while the % of the patient follow-up PT was not: HR = 3.84 [1.13–13.07] when the model was adjusted for cumulative N of DMARDs/patient and 3.16 [1.14–8.77] when also adjusted for baseline SF-36 physical component score. A lower N of cumulative DMARDs/patient was also retained in the models. Receiving operating curve to define the best cutoff of patient follow-up being PT to predict DFR was 21 months: sensitivity of 0.739, specificity of 0.717, and area under the curve of 0.682 (0.544–0.821). DFR status might be added to the benefits of adhering to prescribed treatment.

中文翻译：

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治疗的早期持续性影响无药物缓解：在西班牙裔新发类风湿性关节炎患者队列中的病例对照研究

类风湿关节炎 (RA) 患者的药物依从性欠佳，并且会影响结果。在少数 RA 患者中，无 DMARD 缓解 (DFR) 是一种可持续且可实现的结果。不同的因素与 DFR 相关，尽管治疗持续性 (PT) 是依从性结构的一个组成部分，但从未被检查过。该研究的主要目的是调查 PT 特征对西班牙裔新发 RA 患者队列中 DFR 的影响。一位数据提取者审查了 209 名早期（症状持续时间≤1 年）RA 患者的图表。所有患者都对疾病活动性和 PT 进行了前瞻性评估，并进行了至少 1 年的随访，这是 DFR 定义所必需的。当患者达到 ≥ 1 年的连续疾病活动评分 - 评估的 28 个关节≤ 2.6 时，定义 DFR，不含 DMARD 和皮质类固醇。PT 是根据预先指定的标准定义的，并通过 2004 年至 2008 年的采访以及随后的问卷调查记录下来。根据十个相关变量 (1:2) 将病例（达到 ≥ 1 DFR 状态的患者）与对照组（在整个随访期间从未达到 DFR 的患者）配对。Cox 回归分析根据 PT 的两个特征估计 DFR 的风险比 (HR)：患者随访 PT 的百分比和早期 PT（患者随访的前 2 年）。2022 年 3 月，该人群接受了 112（55-181）名患者/年的随访。随访 74 个月 (44-122) 后，有 23 名患者 (11%) 出现 DFR，并且 DFR 状态在 48 个月 (18-82) 期间保持不变。早期 PT 与 DFR 相关，而患者随访 PT 的百分比与此无关：HR = 3.84 [1.13-13. 07] 当模型针对 DMARDs/患者的累积 N 和 3.16 [1.14-8.77] 进行调整时，还针对基线 SF-36 物理组件得分进行了调整。模型中还保留了较低的 N 累积 DMARD/患者。接受操作曲线来定义患者随访的最佳截止值是 PT 预测 DFR 为 21 个月：敏感性为 0.739，特异性为 0.717，曲线下面积为 0.682（0.544-0.821）。DFR 状态可能会增加坚持规定治疗的好处。特异性为 0.717，曲线下面积为 0.682 (0.544–0.821)。DFR 状态可能会增加坚持规定治疗的好处。特异性为 0.717，曲线下面积为 0.682 (0.544–0.821)。DFR 状态可能会增加坚持规定治疗的好处。