RMD Open
All statistical tests were two-sided, and a p value <0.05 was considered statistically significant.
45.3% to 77.1%) compared with the non-CliDR group (38.1%; 95% CI 29.6% to 47.3%) (p=0.014, figure 2A). The log-rank test revealed a significant difference in remission duration between the two groups ( χ 2=4.675, p=0.031, figure 2B), indicating that patients in the CliDR group experienced a more sustained remission over the 5-year follow-up. Mean sustained remission duration was 44.41 (95% CI 37.07 to 51.75) months for patients in the CliDR group and 38.16 (95% CI 34.15 to 42.17) months for non-CliDR. Because the Kaplan-Meier curves suggested a poten- tial crossing of the survival functions at 5 months, we further examined whether the group effect varied over time by fitting an extended Cox model that included a time-dependent interaction term between group and a dichotomised time covariate split at 5 months (group×I(t>5 months)). This approach tests whether the HR for the group differs before versus after the 5-month cut-off. The interaction term was not statis- tically significant (HR for T_COV_=0.564, 95% CI 0.058 to 5.530, p=0.623), indicating no evidence that the group effect changed over time. Therefore, the proportional hazards assumption was deemed accept- able, and the group effect was considered constant across the entire follow-up period in the final model. During the post-remission follow-up period, the CliDR group experienced 37 recurrence events among 32 patients who developed recurrences. The recur- rence patterns showed that eight patients had single episodes, three patients experienced two recurrences and one patient had three recurrent episodes. The non-CliDR group recorded 80 relapse events occurring in 70 patients. Of these, 60 patients (85.7%) had single relapses, while 10 patients (14.3%) experienced two recurrent episodes. Comparative analysis revealed signifi- cantly lower recurrence rates in the CliDR group versus the non-CliDR group, both in terms of patient propor- tion (37.5% vs 69.1%; p=0.014) and event density (45.0% vs 69.0%; p=0.037). CliDR status modifies the association between drug tapering and relapse risk As shown in table 2, univariable and multivariable Cox proportional hazards models were used to assess factors associated with the outcome. In univariable analyses, vari- ables with a p value <0.10 were considered candidates for the multivariable model. These included group (HR=0.53, 95% CI 0.29 to 0.98, p=0.040), tapering status (HR=4.42, 95% CI 2.78 to 7.02, p<0.001), family history (HR=2.18, 95% CI 1.09 to 4.37, p=0.028), RF titre(HR=1.00, 95% CI 1.00 to 1.001, p=0.075) and comorbidities (HR=0.53, 95% CI 0.33 to 0.87, p=0.012). Multivariable analysis revealed that the effect of tapering differed significantly between the CliDR and non-CliDR groups (interaction HR=0.26, 95% CI 0.07 to 0.98; p=0.046). In the non-CliDR group, tapering was associated with a markedly increased hazard of the outcome (HR=8.47, 95% CI 5.01 to 14.32; p<0.001). In
RESULTS Demographic and clinical characteristics of patients with CliDR or non-CliDR 145 eligible patients were included in the study. The CliDR group included 32 patients, of whom 84.4% were female, with a mean±SD age of 56±13 years. The non- CliDR group comprised 113 patients, with 88.5% being female and a mean±SD age of 54±14 years. No significant differences were observed in age, sex, disease duration, smoking status and family history (p>0.05). Compared with the non-CliDR group, the CliDR group had a significantly less TJC28 (0±0 vs 0.5±0.9, p<0.001), less SJC28 (0±0 vs 0.5±1.2, p<0.001), lower scores of DAS28-CRP (1.6±0.2 vs 2.1±0.3, p<0.001), lower ESR (9.9±4.4 vs 29.2±18.9 mm/hour, p<0.001), lower CRP (2.8±2.1 vs 6.3±6.7 mg/L, p<0.001) and lower proportions of RF positivity (56.3 vs 77.0%, p=0.02). No significant differences were observed in the proportions of anti-CCP positivity. Patients with RA of these two groups had similar frequencies of extra- articular manifestations and comorbidities. At baseline, when DAS28-CRP remission was achieved, the use of combination DMARD therapy was compa- rable between the CliDR and non-CliDR groups (78.1% vs 78.8%). No significant differences were observed in the specific use of individual csDMARDs (eg, MTX: 59.4% vs 46.9%), biologic and targeted synthetic disease- modifying antirheumatic drugs (b/tsDMARDs) (9.4% vs 13.3%) or glucocorticoids (25.0% vs 25.7%). Detailed baseline characteristics are presented in table 1. During the 5-year follow-up after remission, 76/145 (52.4%) of patients underwent drug tapering, with 19/32 (59.4%) in the CliDR group and 57/113 (50.4%) in the non-CliDR group. A similar proportion of patients in the CliDR and non-CliDR groups maintained their original regimen (7/32 (21.9%) vs 17/113 (15.0%)). However, treatment intensification due to disease relapse—either by increasing dose/DMARDs (10/32 (31.3%) vs 62/113 (54.9%)) or switching agents (2/32 (6.3%) vs 8/113 (7.1%))—was notably more frequent in the non-CliDR group. DMARD switches due to adverse events (1/32 (3.1%) vs 8/113 (7.1%)) or other reasons (1/32 (3.1%) vs 2/113 (1.8%)) occurred at low frequencies. The distri- bution of tapered drug classes was well balanced between the CliDR and non-CliDR groups, with no significant differences (Glucocorticoids: 31.3% vs 16.8%, p=0.074; csDMARDs: 18.8% vs 23.9%, p=0.543; b/tsDMARDs: 9.4% vs 9.7%, p=0.952). CliDR associates with higher sustained remission rates and longer remission duration Despite a progressive decline in the sustained remission rate over the 5-year follow-up period, the rate at 5 years was significantly higher in the CliDR group (62.5%; 95% CI
4
Li H, et al . RMD Open 2026; 12 :e006387. doi:10.1136/rmdopen-2025-006387
Powered by FlippingBook