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Objective
To analyse the role of multibiomarker disease activity (MBDA) score in predicting disease relapses in patients with rheumatoid arthritis (RA) in sustained remission who tapered disease modifying antirheumatic drug (DMARD) therapy in RETRO, a prospective randomised controlled trial.
Methods
MBDA scores (scale 1-100) were determined based on 12 inflammation markers in baseline serum samples from 94 patients of the RETRO study. MBDA scores were compared between patients relapsing or remaining in remission when tapering DMARDs. Demographic and disease-specific parameters were included in multivariate logistic regression analysis for defining predictors of relapse.
Results
Moderate-to-high MBDA scores were found in 33% of patients with RA overall. Twice as many patients who relapsed (58%) had moderate/high MBDA compared with patients who remained in remission (21%). Baseline MBDA scores were significantly higher in patients with RA who were relapsing than those remaining in stable remission (N=94; p=0.0001) and those tapering/stopping (N=59; p=0.0001). Multivariate regression analysis identified MBDA scores as independent predictor for relapses in addition to anticitrullinated protein antibody (ACPA) status. Relapse rates were low (13%) in patients who were MBDA-/ACPA-, moderate in patients who were MBDA+/ACPA- (33.3%) and MBDA-ACPA+ (31.8%) and high in patients who were MBDA+/ACPA+ (76.4%).
Conclusions
MBDA improved the prediction of relapses in patients with RA in stable remission undergoing DMARD tapering. If combined with ACPA testing, MBDA allowed prediction of relapse in more than 80% of the patients.
Trial registration number EudraCT
2009-015740-42.
Several studies have shown that tapering or stopping disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients in sustained remission is feasible. However, tapering/stopping bears the risk of decline in physical function as some patients may relapse and face increased disease activity. Here, we analyzed the impact of tapering or stopping DMARD treatment on the physical function of RA patients. The study was a post hoc analysis of physical functional worsening for 282 patients with RA in sustained remission tapering and stopping DMARD treatment in the prospective randomized RETRO study. HAQ and DAS-28 scores were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and HAQ and DAS-28 scores were evaluated every 3 months. The effect of treatment reduction strategy on functional worsening was assessed in a recurrent-event Cox regression model with a study-group (control, taper, and taper/stop) as the predictor. Two-hundred and eighty-two patients were analyzed. In 58 patients, functional worsening was observed. The incidences suggest a higher probability of functional worsening in patients tapering and/or stopping DMARDs, which is likely due to higher relapse rates in these individuals. At the end of the study, however, functional worsening was similar among the groups. Point estimates and survival curves show that the decline in functionality according to HAQ after tapering or discontinuation of DMARDs in RA patients with stable remission is associated with recurrence, but not with an overall functional decline.
Spektroskopie kollektiver Zyklotron- und Intersubband-Resonanzen von Quanten-Hall-Systemen in GaAs
(2008)
Im Mittelpunkt der vorliegenden Arbeit stand das Studium der langwelligen Magneto-Kollektivmoden quasi-zweidimensionaler Elektronengase (Q2DEG) in GaAs. Diese Anregungen, die sich in Zyklotronresonanzen und Magneto-Intersubband-Resonanzen untergliedern, wurden mittels der Ferninfrarot-Fourierspektroskopie in einem Magnetfeldregime 0 T ≤ B ≤ 17 T untersucht. Die Zyklotronresonanz wurde über einen sehr weiten und umfassenden Dichtebereich von 1x10^11 cm^-2 bis 1.2x10^12 cm^-2 im Temperaturintervall 0.3 K < T < 80 K vermessen. Dabei kamen grundlegend unterschiedliche Proben-Strukturen mit Elektronenbeweglichkeiten im Bereich 5x10^5 cm^2/Vs bis 7x10^6 cm^2/Vs zum Einsatz, die unter unterschiedlichen Optimierungsgesichtspunkten hergestellt wurden. Mit den verfügbaren Proben und Parametern konnten mittels der Zyklotronresonanz die Regimes des Integralen (IQHE) und des Fraktionalen Quanten-Hall-Effektes (FQHE) abgedeckt und die bei hohen Temperaturen dominierenden Polaron-Renormierungen grundlegend charakterisiert werden. Zur Analyse und Interpretation der experimentellen Daten wurden theoretische Modelle zur mehrkomponentigen Zyklotronresonanz unte r den Aspekten der Polaron-Renormierung, der Leitungsband-Nichtparabolizität, der Streuung an Störstellen, der Abschirmung, sowie der Elektron-Elektron-Wechselwirkung und den mit ihr zusammenhängenden Grundzuständen entwickelt und mit diesen numerische Modell- und Anpassungsrechnungen durchgeführt. Die Magneto-Intersubband-Resonanzen wurden im Regime des IQHE experimentell untersucht. Dabei wurde die Gitterkopplertechnik zur Ankopplung des Lichtfeldes an diese Anregungen eingesetzt. Zum Verständnis und zur Interpretation der Messergebnisse wurden die selbstkonsistenten Gleichungen zur Berechnung der Magneto-Landau-Subband-Struktur und der dazu kompatiblen Dichteantwort im Rahmen der Hartree-Fock- (HFA) bzw. der zeitabhängigen Hartree-Fock-Näherung (TDHFA) aufgestellt und der numerische Lösungsweg dargelegt. Anhand von Anpassungsrechnungen wurde daraufhin die Magnetfeldabhängigkeit der Intersubband-Resonanzen analysiert.