IMPROVING PATIENT OUTCOME IN RA WITH EARLY ANTIRHEUMATIC DRUG THERAPY

通过早期抗风湿药物治疗改善 RA 患者的预后

• 批准号: 6100636
• 负责人: James F Fries
• 金额: $ 21.52万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-05-01 至 2000-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6100636
• 关键词: X ray; antiarthritic agent; antiinflammatory agents; antirheumatic agents; behavioral /social science research tag; clinical research; computer simulation; drug screening /evaluation; functional ability; gender difference; human genetic material tag; human subject; human therapy evaluation; longitudinal human study; mathematical model; outcomes research; prognosis; quality of life; questionnaires; racial /ethnic difference; rheumatoid arthritis; skeletal disorder chemotherapy; statistics /biometry

Alternative management strategies for rheumatoid arthritis (RA) designed to replace the traditional therapeutic pyramid strategy have recently been proposed and are commonly used, even though evidence for their effectiveness is lacking. The most critical clinical question in RA, therefore, is whether these newer strategies are superior to the old in improving long-term functional and quality-of-life outcomes. These important but very difficult questions may be addressed uniquely using ARAMIS data sets which contain multidisciplinary data including disability, pain and patient global assessment outcomes available in some data sets extending over 15 years. This project will address the questions: 1) Is early and consistent Disease-Modifying Anti-Rheumatic Drug (DMARD) use more effective than Non-steroidal Anti-Inflammatory Drug (NSAID) based therapy and, if so, by how much? 2) Are outcomes in RA improving over time? 3) Are clinical courses and response to therapy similar in various ethnic groups, and in Dr4 positive homozygotes, heterozygotes, and Dr4 negative patients? Pilot studies have suggested positive answers to the first two questions. For this project we will improve the quality and quantity of data relevant to these questions, examine and utilize a new national inception cohort patient sample, and employ five complementary analytic approaches: 1) correlation between medication use and outcomes, including disability, pain, global assessment, and x-ray progression, 2) comparisons of temporal trends in medication use and patient outcomes, 3) comparison among matched patients receiving different treatment strategies, 4) simulation of a randomized controlled trial using new econometric instrumental variables, and 5) decision-analytic modelling of alternative strategies. By these means, we hope to guide physicians toward the most effective treatment strategies and to improve patient outcomes in RA.

类风湿关节炎（RA）设计的替代管理策略 取代传统的治疗金字塔策略 提出并普遍使用，即使证据证明了他们 缺乏有效性。 RA中最关键的临床问题， 因此，这些新策略是否优于旧策略 改善长期功能和生活质量结果。这些 重要但非常困难的问题可以使用 ARAMIS数据集包含多学科数据，包括 某些人可以提供残疾，疼痛和患者全球评估结果 数据集延长了15年。 该项目将解决 问题：1）是早期且一致的疾病改良的抗疾病 药物（DMARD）使用比非甾体类抗炎药更有效 （NSAID）基于多少疗法，如果是的，则需要多少？ 2）是RA的结果 随着时间的流逝而改善？ 3）是临床课程和对治疗的反应 在各个族裔和DR4阳性纯合子中相似， 杂合子和DR4阴性患者？试点研究表明 对前两个问题的积极答案。对于这个项目，我们将 提高与这些问题相关的数据的质量和数量， 检查并利用新的国家成立队列患者样本，以及 采用五种互补分析方法：1） 用药和结果，包括残疾，疼痛，全球 评估和X射线进展，2）比较时间趋势的 用药和患者预后，3）匹配患者的比较 接受不同的治疗策略，4）模拟随机的 使用新计量器仪器变量的对照试验，5） 替代策略的决策分析建模。通过这些手段， 我们希望指导医生采取最有效的治疗 策略并改善RA的患者预后。