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van de Laar CJ, Oude Voshaar MAH, Ten Klooster P, Tedjo DI, Bos R, Jansen T, Willemze A, Versteeg GA, Goekoop-Ruiterman YPM, Kroot EJ, van de Laar M. PERFECTRA: a pragmatic, multicentre, real-life study comparing treat-to-target strategies with baricitinib versus TNF inhibitors in patients with active rheumatoid arthritis after failure on csDMARDs. RMD Open 2024; 10:e004291. [PMID: 38816210 DOI: 10.1136/rmdopen-2024-004291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To compare the effectiveness of a strategy administering baricitinib versus one using TNF-inhibitors (TNFi) in patients with rheumatoid arthritis (RA) after conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) failure in a real-life treat-to-target (T2T) setting. METHODS Patients with biological and targeted synthetic DMARD (b/tsDMARD) naïve RA with disease duration ≤5 years without contraindications to b/tsDMARD were randomised to either TNFi or baricitinib when csDMARD failed to achieve disease control in a T2T setting. Changes in clinical and patient-reported outcome measures (PROMs) were assessed at 12-week intervals for 48 weeks. The primary endpoint was non-inferiority, with testing for superiority if non-inferiority is demonstrated, of baricitinib strategy in the number of patients achieving American College of Rheumatology 50 (ACR50) response at 12 weeks. Secondary endpoints included 28-joint count Disease Activity Score with C reactive protein (DAS28-CRP) <2.6, changes in PROMs and radiographic progression. RESULTS A total of 199 patients (TNFi, n=102; baricitinib, n=97) were studied. Both study groups were similar. Baricitinib was both non-inferior and superior in achieving ACR50 response at week 12 (42% vs 20%). Moreover, 75% of baricitinib patients achieved DAS28-CRP <2.6 at week 12 compared with 46% of TNFi patients. On secondary outcomes throughout the duration of the study, the baricitinib strategy demonstrated comparable or better outcomes than TNFi strategy. Although not powered for safety, no unexpected safety signals were seen in this relatively small group of patients. CONCLUSION Up to present, in a T2T setting, patients with RA failing csDMARDs have two main strategies to consider, Janus Kinases inhibitor versus bDMARDs (in clinical practice, predominantly TNFi). The PERFECTRA study suggested that starting with baricitinib was superior over TNFi in achieving response at 12 weeks and resulted in improved outcomes across all studied clinical measures and PROMs throughout the study duration in these patients.
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Affiliation(s)
- Celine J van de Laar
- Transparency in Healthcare BV, Hengelo, Netherlands
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, Netherlands
| | - Martijn A H Oude Voshaar
- Department of Medical Cell BioPhysics & TechMed Center, University of Twente, Enschede, Overijssel, Netherlands
| | - Peter Ten Klooster
- Transparency in Healthcare bv @ University of Twente, Hengelo, Netherlands
- Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Overijssel, Netherlands
| | - Danyta I Tedjo
- Transparency in Healthcare bv @ University of Twente, Hengelo, Netherlands
| | - Reinhard Bos
- Rheumatology, Medical Centre Leeuwarden, Leeuwarden, Fryslân, Netherlands
| | - Tim Jansen
- Rheumatology, VieCuri Medical Centre, Venlo, Limburg, Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands
| | - Grada A Versteeg
- Rheumatology, Deventer Hospital, Deventer, Overijssel, Netherlands
| | | | | | - Mart van de Laar
- Transparency in Healthcare bv @ University of Twente, Hengelo, Netherlands
- Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Overijssel, Netherlands
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Hao Y, Oon S, Nikpour M. Efficacy and safety of treat-to-target strategy studies in rheumatic diseases: A systematic review and meta-analysis. Semin Arthritis Rheum 2024; 67:152465. [PMID: 38796922 DOI: 10.1016/j.semarthrit.2024.152465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The concept of treat-to-target (T2T), a treatment strategy in which treatment is directed to reach and maintain a defined goal such as remission or low disease activity (LDA), has been explored for several diseases including rheumatic diseases such as rheumatoid arthritis (RA). However, a comprehensive review of T2T in all rheumatic diseases has not recently been undertaken. OBJECTIVE To perform a systematic review and meta-analysis of the efficacy and safety of a T2T strategy in the management of adult patients with inflammatory rheumatic diseases. METHODS PUBMED, EMBASE and CINAHL were searched from January 1990 to December 2023 using key words related to a T2T strategy and rheumatic diseases; T2T strategy clinical trials or observational studies were included. Clinical, physical function and radiologic outcomes, cost-effectiveness, and adverse events (AEs) of the T2T strategies were investigated and a random-effect meta-analysis was conducted for the most commonly used outcomes in RA studies. RESULTS The search identified 7896 studies, of which 66 fit inclusion criteria, including 50 in RA, 3 in psoriatic arthritis (PsA), 1 in spondyloarthritis (SpA) and 12 in gout. For the studies comparing a T2T strategy with usual care (UC) in RA, 83.3% (20/24) showed a T2T strategy could achieve significantly better clinical outcomes, and the meta-analysis showed that patients treated with a T2T strategy were more likely to be in remission (pooled RR: 1.68 (1.47-1.92), p<0.001] and achieve DAS-28 response (pooled standardised mean difference (SMD): 0.47 (0.26-0.69), P<0.001] at 1 year than patients treated with UC. Sensitivity analyses showed that a T2T strategy with a predefined treatment protocol had better clinical efficacy than that without protocol. In terms of improving physical function and health-related quality of life (HRQoL), 11/19 (57.9%) studies found a T2T strategy was significantly more likely to achieve these than UC, with the meta-analysis for the mean change of HAQ score supporting this conclusion (pooled SMD: 1.48 (0.46-2.51), p=0.004). Five out of 9 studies (55.6%) demonstrated greater benefit regarding radiographic progression from a T2T strategy. In terms of cost-effectiveness and AEs, 2/2 studies found a T2T strategy was more cost-effective than UC and 8/8 studies showed no tendency for AEs to occur more often with a T2T strategy. For the studies in PsA and SpA, a T2T strategy was also demonstrated to be more effective than UC in clinical and functional benefits, but not in radiologic outcomes. All gout studies showed that sUA level could be controlled more effectively with a T2T strategy, and 2 studies revealed that the T2T strategy could inhibit erosion development or crystal deposition. CONCLUSIONS For patients with active RA, a T2T strategy has been shown in mulitple studies to increase the likelihood of achieving clinical response and improving HRQoL without increasing economic costs and AEs. Limited studies have shown clinical and functional benefits from T2T strategies in active PsA and SpA. A T2T strategy has also been found to improve clinical and radiologic outcomes in gout. T2T trials in other rheumatic diseases are lacking.
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Affiliation(s)
- Yanjie Hao
- The University of Melbourne at St Vincent's Hospital, 29 Regent Street, Fitzroy, VIC 3065, Australia
| | - Shereen Oon
- The University of Melbourne at St Vincent's Hospital, 29 Regent Street, Fitzroy, VIC 3065, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital, 29 Regent Street, Fitzroy, VIC 3065, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, 35 Victoria Parade, Fitzroy, VIC 3065, Australia; Sydney MSK Research Flagship Centre, The University of Sydney School of Public Health, Room 132, Edward Ford Building, Fisher Road, University of Sydney, NSW 2006, Australia; Royal Prince Alfred Hospital Institute of Rheumatology and Orthopedics, 59 Missenden Rd, Camperdown NSW 2050, Australia.
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Velthuis K, Poppelaars F, Ten Klooster PM, Vonkeman HE, Jessurun NT. Impact of adverse drug reactions on the treatment pathways of early rheumatoid arthritis patients: a prospective observational cohort study. Expert Opin Drug Saf 2023; 22:753-762. [PMID: 36946179 DOI: 10.1080/14740338.2023.2194628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Several patient characteristics may be of influence on treatment pathways of rheumatoid arthritis (RA) patients in clinical practice. The aim of this study is to analyze treatment pathways of early RA patients stratified for gender and adverse drug reaction (ADR) occurrence. RESEARCH DESIGN AND METHODS Treatment pathways of patients included in the DREAM-RA treat-to-target cohort I between 16th of July 2006-30th of April 2020 were assessed. Treatment pathways were visualized in Sankey diagrams. Follow-up time, duration per treatment and the number of treatments received were stratified for gender and ADR occurrence and analyzed. Independent t-tests and chi-square tests were performed where applicable. RESULTS Treatment pathways of 372 patients (follow-up: 2488.4 years, mean 6.7 ± 3.7 years) were analyzed. The Sankey diagrams visualize that treatment pathways became increasingly varied and complex over time. No significant differences were found when comparing female patients and male patients. However, the average treatment duration was shorter in patients with ADRs (1.8 vs. 2.7 years, p < 0.05), and the number of treatments higher (3.5 vs. 2.5, p < 0.05). CONCLUSIONS Treatment pathways increase in complexity over time. Differences were found between patients with and without ADRs, with patients that experience ADRs receiving more and shorter treatments.
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Affiliation(s)
- Kimberly Velthuis
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | - Fenna Poppelaars
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
| | - Peter M Ten Klooster
- Transparency in Healthcare B.V, Hengelo, Netherlands
- Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Harald E Vonkeman
- Psychology, Health & Technology, University of Twente, Enschede, Netherlands
- Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, Netherlands
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Matrix Metalloproteinase-9 Level in Synovial Fluid-Association with Joint Destruction in Early Rheumatoid Arthritis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010167. [PMID: 36676791 PMCID: PMC9863294 DOI: 10.3390/medicina59010167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
Background and objective: Matrix metalloproteinases (MMPs) are the key enzymes in the pathogenesis of cartilage and joint damage and potentially a new biomarker of the early erosive form of rheumatoid arthritis (RA). Firstly, the study aimed to compare the level of MMP-9 in plasma (PL) and synovial fluid (SF) of patients with RA and osteoarthritis (OA). Secondly, the goal was to examine the association of MMP-9 level in PL and SF with early erosive changes in RA, and finally, to determine the association of MMP-9 level with serological parameters of the disease (rheumatoid factor-RF and anti-citrulline protein antibodies-ACPA). Materials and Methods: A total of 156 subjects were involved in this study (84 patients with RA and 72 patients with OA, who were involved as a control group). MMP-9 level was measured in PL and SF of all subjects by the sandwich enzyme-linked immunosorbent assay (ELISA) method. Standard radiographs of the hands and feet were used to detect joint damage and classification into erosive or non-erosive RA. The Larsen score (LS) was used for the quantitative assessment of joint damage, and its annual change (∆ LS) was used to assess the radiographic progression of the disease. Results: MMP-9 level in PL and SF was significantly higher in RA compared to controls (PL: 19.26 ± 7.54 vs. 14.57 ± 3.11 ng/mL, p< 0.01; SF: 16.17 ± 12.25 vs. 0.75 ± 0.53 ng/mL, p < 0.001) as well as in SF of patients with erosive compared to non-erosive RA (18.43 ± 12.87 vs. 9.36 ± 7.72; p < 0.05). Faster radiographic progression was recorded in erosive compared to non-erosive early RA (11.14 ± 4.75 vs. 6.13 ± 2.72; p < 0.01). MMP-9 level in SF, but not in PL, significantly correlates with the radiographic progression in both erosive and non-erosive RA (ρ = 0.38 and ρ = 0.27). We did not find a significant association between RF and MMP-9 level in early RA, but the ACPA level significantly correlates with MMP-9 level in SF (r = 0.48). Conclusion: The level of MMP-9 in plasma and synovial fluid of patients with RA is significantly higher compared to patients with osteoarthritis. The level of MMP-9 in synovial fluid is significantly higher in erosive than non-erosive early RA. It is significantly associated with the radiographic progression of the disease and the level of anti-citrulline protein antibodies.
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Larid G, Vix J, Garlantezec R, Loppin E, Gervais E. Increased remission with fewer corticosteroids and more biologics in rheumatoid arthritis at 7-year follow-up in real-life conditions. Sci Rep 2022; 12:2563. [PMID: 35169251 PMCID: PMC8847581 DOI: 10.1038/s41598-022-06584-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Remission in rheumatoid arthritis (RA) is an important therapeutic target that is not easy to achieve in real-life conditions. Some prognostic factors have been identified but the literature is variable. The objectives of this study were to evaluate the remission rate and the maintenance of remission in patients with RA over 7 years of follow-up in real-life conditions and to identify prognostic factors of long-term remission. Patients with RA seen at the Poitiers University Hospital were identified and clinical and biological data were collected. Data were analysed after 1 year and 7 years. Twice as many patients were in remission at 7 years than at 1 year of follow-up. 48.6% of patients who were not in remission at 1 year obtained remission at 7 years of follow-up. Patients achieving remission were more often receiving coprescription of csDMARDs and bDMARDs. Patients not in remission at 7 years were given more corticosteroids at higher doses. After 7 years of follow-up, low initial disease activity and use of csDMARDs and bDMARDs appeared to be independent positive predictive factors. Once obtained at one year, remission was maintained for 76% of our patients. As a conclusion, modern management of RA, whatever disease duration, leads to remission rates similar to those of early RA after 7 years of follow-up.
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Affiliation(s)
- Guillaume Larid
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France.,LITEC Laboratory, EA 4331, Poitiers University, Poitiers, France
| | - Justine Vix
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France
| | | | - Elodie Loppin
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France
| | - Elisabeth Gervais
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France. .,LITEC Laboratory, EA 4331, Poitiers University, Poitiers, France.
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Van Lint JA, Bakker T, Ten Klooster PM, van Puijenbroek EP, Vonkeman HE, Jessurun NT. Neuropsychiatric adverse drug reactions associated with low dose methotrexate in rheumatoid arthritis patients. Expert Opin Drug Saf 2021; 21:417-423. [PMID: 34739327 DOI: 10.1080/14740338.2022.2003328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neuropsychiatric adverse drug reactions (NPADRs) are not commonly associated with low dose methotrexate (LDMTX) in patients with rheumatoid arthritis (RA). RESEARCH DESIGN AND METHODS In this case series assessment, we described the nature and frequency of NPADRs with LDMTX in the Dutch DREAM-RA registry, including causality of NPADRs, the impact on further LDMTX treatment and the impact on patient reported Health Related Quality of Life (HRQoL). RESULTS A total of 71 NPADRs (frequency 6.8%) associated with LDMTX were captured in the DREAM-RA registry. NPADRs were registered for 62 (5.9%) out of 1048 patients with 10.9 NPADRs per 1000 patient years. Headache, dizziness and depression were most frequently reported. The causality was considered probable for 67 NPADRs (94.4%) and definite for 1 NPADR (1.4%). NPADRs led to LDMTX withdrawal in 34 cases (47.9%) and was not restarted in 16 cases (47.1%). Median mental HRQoL was significantly decreased around the occurrence of the NPADR and remained significantly lower after the event. Median physical HRQoL was not significantly affected. CONCLUSIONS Knowledge on the nature, frequency and impact of the demonstrated NPADRs during LDMTX therapy will enhance attention toward these potential ADRs allowing better risk assessment and communication to patients.
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Affiliation(s)
- Jette A Van Lint
- Netherlands Pharmacovigilance Centre Lareb, 'S-Hertogenbosch, The Netherlands
| | - Tom Bakker
- Netherlands Pharmacovigilance Centre Lareb, 'S-Hertogenbosch, The Netherlands
| | - Peter M Ten Klooster
- Transparency in Healthcare B.V, Hengelo, The Netherlands.,Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Eugene P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 'S-Hertogenbosch, The Netherlands.,Pharmacotherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb, 'S-Hertogenbosch, The Netherlands
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Hegeman MC, Schoemaker-Delsing JA, Luttikholt JTM, Vonkeman HE. Patient perspectives on how to improve education on medication side effects: cross-sectional observational study at a rheumatology clinic in The Netherlands. Rheumatol Int 2021; 41:973-979. [PMID: 33730208 PMCID: PMC8019410 DOI: 10.1007/s00296-021-04815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
Rheumatoid arthritis (RA) patients often report lacking information on medication side effects. The aims of this study were to observe how rheumatology healthcare providers deliver medication information and to determine in which specific domains information is missing. First, 12 single-blinded structured observations were performed during regular RA patient consultations. The observers noted whether and how medication and medication side effects were discussed. Second, 100 RA patients were asked to fill out an adaptation of the Satisfaction with Information about Medicines Scale (SIMS). Medication was discussed during all observed consultations. With new medication, its purpose and mode of action were explained in all cases, but possible side effects in only 33%. Overall, medication side effects were discussed in 58% of consultations. Most information delivery was verbal (92%). Response rate to the questionnaire was 61%. Overall satisfaction with medication education was mean 7.3 (± 1.9) (NRS 0-10) with a comparable high SIMS total satisfaction sum score of mean 12.3 (± 4.4). At subscale score levels, 89% were satisfied with the amount of information on the action and usage of medication, but only 47% with the information on the potential problems of medication. RA patients express overall high satisfaction with their medication education but there is still an unmet need for information on potential risks and side effects. Using the SIMS questionnaire in daily clinical practice may help focus medication education to the needs of the individual patient.
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Affiliation(s)
- Mirjam C Hegeman
- Department Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. .,Department Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands.
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Giraud EL, Jessurun NT, van Hunsel FPAM, van Puijenbroek EP, van Tubergen A, Ten Klooster PM, Vonkeman HE. Frequency of real-world reported adverse drug reactions in rheumatoid arthritis patients. Expert Opin Drug Saf 2020; 19:1617-1624. [PMID: 32990050 DOI: 10.1080/14740338.2020.1830058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe the cumulative incidences of adverse drug reactions (ADRs) associated with disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients from real-world data (RWD), using the DREAM-RA registry, and to compare these with incidence frequencies mentioned in the Summary of Product Characteristics (SmPC). METHODS All ADRs in patients with recorded use of adalimumab, etanercept, hydroxychloroquine, leflunomide, oral and subcutaneous methotrexate, and sulfasalazine from a single center participating in the DREAM-RA registry (n = 1,098 patients) that were directly sent to the Netherlands Pharmacovigilance Center Lareb were assessed. Cumulative incidences were calculated, described and compared to the most recently revised SmPCs. RESULTS In total, 14 ADRs (≥5 case reports) associated with the use of one of the included DMARDs were reported with a higher estimated cumulative incidence compared to the SmPC. For hydroxychloroquine and sulfasalazine, 5 ADRs (≥5 case reports) mentioned with an 'unknown' incidence in the SmPC were reported as 'common' in this study. CONCLUSIONS Although ADR data in the DREAM-RA registry were partly comparable with data in the SmPCs, RWD from this patient registry provided an added value to the currently available information on the incidences of ADRs associated with DMARDs in RA patients as described in SmPCs.
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Affiliation(s)
- Eline L Giraud
- Netherlands Pharmacovigilance Centre Lareb , 's-Hertogenbosch, The Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb , 's-Hertogenbosch, The Netherlands
| | | | | | - Astrid van Tubergen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands and Care and Public Health Research Institute (CAPHRI), Maastricht University , Maastricht, The Netherlands
| | - Peter M Ten Klooster
- Transparency in Healthcare B.v ., Hengelo, The Netherlands.,Department of Psychology, Health & Technology, University of Twente , Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health & Technology, University of Twente , Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente , Enschede, The Netherlands
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Van De Laar CJ, Oude Voshaar MAH, Fakhouri WKH, Zaremba-Pechmann L, De Leonardis F, De La Torre I, Van De Laar MAFJ. Cost-Effectiveness of a JAK1/JAK2 Inhibitor vs a Biologic Disease-Modifying Antirheumatic Drug (bDMARD) in a Treat-to-Target Strategy for Rheumatoid Arthritis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:213-222. [PMID: 32346301 PMCID: PMC7167259 DOI: 10.2147/ceor.s231558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Background Baricitinib is a janus kinase (JAK1/JAK2) inhibitor developed for the treatment of patients suffering from rheumatoid arthritis (RA). Treating RA to the target of remission is current common practice. Cost-effectiveness of different treat-to-target (T2T) strategies, especially ones including new treatments is important for development and preference policy for treatment centers. European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) guidelines are currently unclear about preference between a JAK1/JAK2 versus a biological disease-modifying antirheumatic drug (bDMARD). Objective The main goal of this paper was to evaluate the cost-effectiveness of baricitinib versus first biological for methotrexate inadequate responders in a T2T strategy using a Markov model that incorporates hospital costs as well as societal costs. Costs and utilities over five years were compared between the two strategies. Methods A Monte Carlo simulation model was developed to conduct cost–utility analysis from the societal perspective over 5 years. Health states were based on the DAS28-erythrocyte sedimentation rate (ESR) categories. Effectiveness of baricitinib was retrieved from randomized controlled trials. Effectiveness of all other treatments, health state utilities, medical costs, and productivity loss were retrieved from the Dutch RhEumatoid Arthritis Monitoring (DREAM) cohorts. Annual discount rates of 1.5% for utility and 4% for costs were used. Probabilistic sensitivity analysis was employed to incorporate uncertainty and assess robustness of the results. Results Probabilistic sensitivity analysis results showed the baricitinib strategy yielded lower costs and higher utility over a 5-year period. Scenario analyses showed the baricitinib strategy to be cost-effective in both the moderate and severe RA populations. Conclusion Results suggest that the use of a JAK1/JAK2 inhibitor instead of a bDMARD in a T2T approach is cost-effective in csDMARD refractory RA patients.
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Affiliation(s)
| | - Martijn A H Oude Voshaar
- Transparency in Healthcare BV, Hengelo, the Netherlands.,Department of Psychology and Communication of Health and Risk, Institute for Behavioural Research, University of Twente, Enschede, the Netherlands
| | | | | | | | | | - Mart A F J Van De Laar
- Transparency in Healthcare BV, Hengelo, the Netherlands.,Department of Psychology and Communication of Health and Risk, Institute for Behavioural Research, University of Twente, Enschede, the Netherlands
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Disease activity-based management of rheumatoid arthritis in Dutch daily clinical practice has improved over the past decade. Clin Rheumatol 2020; 39:1131-1139. [PMID: 31997083 DOI: 10.1007/s10067-019-04913-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022]
Abstract
To re-evaluate the adherence to clinical practice guidelines recommended disease activity-based management of rheumatoid arthritis (RA) in daily clinical practice, among Dutch rheumatologists in the past decade. In 2007, disease activity was measured in only 16% of outpatient visits. All rheumatologists that participated in the 2007 study were invited to re-enter our study in 2016/2017. If necessary, data were supplemented with data from other rheumatologists. For all 26 rheumatologists who agreed to participate in our study, data were collected from 30 consecutive patients that visited the outpatient clinic. Per patient, data from four consecutive rheumatologist outpatient visits were collected. Since 2007, disease activity was measured more frequently in Dutch daily clinical practice, increasing from 16 to 79% of visits (2440/3081 visits). In addition, intensification of medication based on disease activity scores increased from 33 to 50% of visits (260/525 visits). DAS/DAS28 was the most frequently used disease activity measure (1596/2440 visits). There was a wide variation among rheumatologists in measuring disease activity and intensification of medication, 20-100% and 0-75% respectively. Over the past years, there has been a large improvement in disease activity assessment in daily clinical practice. Disease activity-based medication intensifications, also called tight control or treat to target, increased to a lesser extent. Large variation between different rheumatologists and clinics indicates that there is still room for improvement. Key Points • Following guideline dissemination disease activity is assessed more frequently (79%). • There is large variation between rheumatologists, indicating room for improvement. • Finding factors that explain variation is necessary to improve tight control in daily practice.
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11
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Carpenter L, Barnett R, Mahendran P, Nikiphorou E, Gwinnutt J, Verstappen S, Scott DL, Norton S. Secular changes in functional disability, pain, fatigue and mental well-being in early rheumatoid arthritis. A longitudinal meta-analysis. Semin Arthritis Rheum 2019; 50:209-219. [PMID: 31521376 DOI: 10.1016/j.semarthrit.2019.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To conduct a systematic review and longitudinal meta-analysis of early rheumatoid arthritis (RA) cohorts with long-term data on pain, fatigue or mental well-being. METHODS Searches using PUBMED, EMBASE and PyscInfo were performed to identify all early RA cohorts with longitudinal measures of pain, fatigue or mental well-being, along with clinical measures. Using longitudinal meta-analyses, the progression of each outcome over the first 60-months was estimated. Cohorts were stratified based on the median recruitment year to investigate secular trends in disease progression. RESULTS Of 7,319 papers identified, 75 met the inclusion criteria and 46 cohorts from 41 publications provided sufficient data on 18,046 patients for meta-analysis. The Disease Activity Scores (DAS28) and the Short-Form 36 (SF-36) Physical Component Score (PCS) indicated that post-2002 cohorts had statistically significant improvements over the first 60-months compared to pre-2002 cohorts, with standardised mean differences (SMD) of 0.86 (95% Confidence Intervals 0.34 to 1.37) and 0.76 (95% CI 0.25 to 1.27) respectively at month-60. However, post-2002 cohorts indicated statistically non-significant improvements in pain, fatigue, functional disability and SF-36 Mental Component Score (MCS) compared to pre-2002 cohorts, with SMD of 0.24 (95% CI -0.25 to 0.74), 0.38 (95% CI -0.11 to 0.88), 0.34 (95% CI -0.15-0.84) and -0.08 (95% CI -0.41 to 0.58) at month-60 respectively. CONCLUSIONS Recent cohorts indicate improved levels of disease activity and physical quality of life, however this has not translated into similar improvements in levels of pain, fatigue and functional disability by 60-months.
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Affiliation(s)
- L Carpenter
- Health Psychology Section, King's College London, London, United Kingdom.
| | - R Barnett
- Health Psychology Section, King's College London, London, United Kingdom
| | - P Mahendran
- Health Psychology Section, King's College London, London, United Kingdom
| | - E Nikiphorou
- Department of Inflammation Biology, King's College London, London, United Kingdom
| | - J Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - S Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - D L Scott
- Department of Inflammation Biology, King's College London, London, United Kingdom
| | - S Norton
- Health Psychology Section, King's College London, London, United Kingdom; Department of Inflammation Biology, King's College London, London, United Kingdom
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12
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Genovese MC, van der Heijde D, Lin Y, St John G, Wang S, van Hoogstraten H, Gómez-Reino JJ, Kivitz A, Maldonado-Cocco JA, Seriolo B, Stanislav M, Burmester GR. Long-term safety and efficacy of sarilumab plus methotrexate on disease activity, physical function and radiographic progression: 5 years of sarilumab plus methotrexate treatment. RMD Open 2019; 5:e000887. [PMID: 31452928 PMCID: PMC6691511 DOI: 10.1136/rmdopen-2018-000887] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 01/12/2023] Open
Abstract
Objective In MOBILITY (NCT01061736), sarilumab significantly reduced disease activity, improved physical function and inhibited radiographic progression at week 52 versus placebo in patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate. We report 5-year safety, efficacy and radiographic outcomes of sarilumab from NCT01061736 and the open-label extension (EXTEND; NCT01146652), in which patients received sarilumab 200 mg every 2 weeks (q2w) + methotrexate. Methods Patients (n=1197) with moderately to severely active RA were initially randomised to placebo, sarilumab 150 mg or sarilumab 200 mg subcutaneously q2w plus weekly methotrexate for 52 weeks. Completers were eligible to enrol in the open-label extension and receive sarilumab 200 mg q2w + methotrexate. Results Overall, 901 patients entered the open-label extension. The safety profile remained stable over 5-year follow-up and consistent with interleukin-6 receptor blockade. Absolute neutrophil count <1000 cells/mm3 was observed but not associated with increased infection rate. Initial treatment with sarilumab 200 mg + methotrexate was associated with reduced radiographic progression over 5 years versus sarilumab 150 mg + methotrexate or placebo + methotrexate (mean±SE change from baseline in van der Heijde-modified Total Sharp Score: 1.46±0.27, 2.35±0.28 and 3.68±0.27, respectively (p<0.001 for each sarilumab dose versus placebo)). Clinical efficacy was sustained through 5 years according to Disease Activity Score (28-joint count) using C reactive protein, Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire-Disability Index. The number of patients achieving CDAI ≤2.8 at 5 years was similar among initial randomisation groups (placebo, 76/398 (19%); sarilumab 150 mg, 68/400 (17%); sarilumab 200 mg, 84/399 (21%)). Conclusion Clinical efficacy, including inhibition of radiographic progression, reduction in disease activity and improvement in physical function, was sustained with sarilumab + methotrexate over 5 years. Safety appeared stable over the 5-year period.
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Affiliation(s)
- Mark C Genovese
- Stanford University Medical Center, Palo Alto, California, USA
| | | | - Yong Lin
- Sanofi Genzyme, Bridgewater, New Jersey, USA
| | | | | | | | - Juan José Gómez-Reino
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | | | - Bruno Seriolo
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Marina Stanislav
- Research Rheumatology Institute n. a. V.A. Nasonova, Moscow, Russia
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
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13
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Ten Klooster PM, Oude Voshaar MAH, Fakhouri W, de la Torre I, Nicolay C, van de Laar MAFJ. Long-term clinical, functional, and cost outcomes for early rheumatoid arthritis patients who did or did not achieve early remission in a real-world treat-to-target strategy. Clin Rheumatol 2019; 38:2727-2736. [PMID: 31161488 DOI: 10.1007/s10067-019-04600-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To retrospectively compare the long-term clinical, functional, and cost outcomes for early RA patients (symptoms < 1 year) who did or did not achieve early remission in a treat-to-target strategy. METHOD Five-year data of 471 patients included in the DREAM remission induction cohort were used. Patients were treated according to a pre-specified 28-joint Disease Activity Score (DAS28) remission driven step-up treatment strategy starting with methotrexate, addition of sulfasalazine, and exchange of sulfasalazine for biological medication in case of failure. Two- and 3-year healthcare costs were available for selected subsamples of patients only. RESULTS DAS28 remission was achieved in 27.7%, 38.2%, and 51.6% of patients at 2, 3, and 6 months, respectively. Achieving DAS28 remission at 2, 3, or 6 months was consistently associated with significantly lower DAS28 and Health Assessment Questionnaire-Disability scores at 1, 3, and 5 years of follow-up (all P values < 0.02). Patients in remission at 2, 3, or 6 months also had significantly lower medication costs per patient over the first 2 and 3 years of treatment, mainly due to lower biologic use, but differences in total healthcare resource costs (hospital admissions plus consultations) were less pronounced. Mean total medication and total healthcare resource costs at 3 years were €1131 and €1757 for patients in remission at 6 months vs. €7533 (P < 0.01) and €2202 (P = 0.09) for those not in remission. CONCLUSION Achieving early remission was associated with beneficial clinical outcomes for early RA patients and lower costs in the long term. Key Points • Previous studies in rheumatoid arthritis patients have demonstrated that early good response is associated with sustained remission and better long-term clinical outcomes. • This study extents these findings by examining the long-term benefits of achieving early remission on clinical, patient-reported, and economic outcomes in a real-world cohort of patients with very early rheumatoid arthritis treated according to treat-to-target principles. • The findings of this study clearly demonstrate that aiming for early remission in rheumatoid arthritis patients is beneficial in the long-term in terms of better clinical and functional outcomes and lower healthcare costs.
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Affiliation(s)
- Peter M Ten Klooster
- Transparency in Healthcare, Hengelo, The Netherlands. .,Arthritis Centre Twente, University of Twente, Enschede, The Netherlands. .,Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Martijn A H Oude Voshaar
- Transparency in Healthcare, Hengelo, The Netherlands.,Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | | | | | - Claudia Nicolay
- Lilly Deutschland GmbH, Eli Lilly and Company, Bad Homburg, Germany
| | - Mart A F J van de Laar
- Transparency in Healthcare, Hengelo, The Netherlands.,Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.,Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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14
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Clinical predictors of remission and low disease activity in Latin American early rheumatoid arthritis: data from the GLADAR cohort. Clin Rheumatol 2019; 38:2737-2746. [PMID: 31161486 DOI: 10.1007/s10067-019-04618-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/12/2019] [Accepted: 05/19/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort. METHODS Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR (< 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms' duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05). RESULTS Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07-1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04-2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17-1.6; p < 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26-1.61; p < 0.001), non-use of corticosteroid (OR 1.74; CI 1.11-2.44; p = 0.008), and male gender (OR 1.77; CI 1.2-2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23-1.70; p < 0.001) was the only predictor of LDA/remission at 2 years. CONCLUSIONS A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RA patients from the GLADAR cohort. Key Points • In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently. • Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline. • Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.
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15
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Update of the Mexican College of Rheumatology Guidelines for the Pharmacological Treatment of Rheumatoid Arthritis, 2018. ACTA ACUST UNITED AC 2019; 17:215-228. [PMID: 31103432 DOI: 10.1016/j.reuma.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
Therapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines. OBJECTIVE To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. METHOD Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. RESULTS Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. CONCLUSIONS The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.
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van de Laar CJ, Oude Voshaar MAH, Vonkeman HE. Cost-effectiveness of different treat-to-target strategies in rheumatoid arthritis: results from the DREAM registry. BMC Rheumatol 2019; 3:16. [PMID: 31168521 PMCID: PMC6487515 DOI: 10.1186/s41927-019-0064-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background Adjusting medication of patients with rheumatoid arthritis (RA) until predefined disease activity targets are met, i.e. Treat-to-Target (T2T), is the currently recommended treatment approach. However, not much is known about long-term cost-effectiveness of different T2T strategies. We model the 5-year costs and effects of a step-up approach (MTX mono - > MTX + csDMARD combination - > Adalimumab - > second anti-TNF) and an initial combination therapy approach (MTX + csDMARD - > MTX + csDMARD higher dose - > anti-TNFs) from the healthcare and societal perspectives, by adapting a previously validated Markov model. Methods We constructed a Markov model in which 3-monthly transitions between DAS28-defined health states of remission (≤2.6), low (2.6 < DAS28 ≤ 3.2), moderate (3.2 < DAS28 ≤ 5.1), and high disease activity (DAS28 > 5.1) were simulated. Modelled patients proceeded to subsequent treatments in case of non-remission at each (3-month) cycle start. In case of remission for two consecutive cycles medication was tapered, until medication-free remission was achieved. Transition probabilities for individual treatment steps were estimated using data of Dutch Rheumatology Monitoring registry Remission Induction Cohort I (step-up) and II (initial combination). Expected costs, utility, and ICER after 5 years were compared between the two strategies. To account for parameter uncertainty, probabilistic sensitivity analysis was employed through Gamma, Normal, and Dirichlet distributions. All utilities, costs, and transition probabilities were replaced by fitted distributions. Results Over a 5-year timespan, initial combination therapy was less costly and more effective than step-up therapy. Initial combination therapy accrued €16,226.3 and 3.552 QALY vs €20,183.3 and 3.517 QALYs for step-up therapy. This resulted in a negative ICER, indicating that initial combination therapy was both less costly and more effective in terms of utility gained. This can be explained by higher (±5%) remission percentages in initial combination strategy at all time points. More patients in remission generates less healthcare and productivity loss costs and higher utility. Additionally, higher remission percentages caused less bDMARD use in the initial combination strategy, lowering overall costs. Conclusion Initial combination therapy was found favourable over step-up therapy in the treatment of Rheumatoid Arthritis, when considering cost-effectiveness. Initial combination therapy resulted in more utility at a lower cost over 5 years. Electronic supplementary material The online version of this article (10.1186/s41927-019-0064-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Celine J van de Laar
- 1Arthritis Center Twente, Medisch Spectrum Twente, University of Twente, Enschede, The Netherlands.,Transparency in Healthcare b.v., Hengelo, The Netherlands
| | - Martijn A H Oude Voshaar
- 1Arthritis Center Twente, Medisch Spectrum Twente, University of Twente, Enschede, The Netherlands.,Transparency in Healthcare b.v., Hengelo, The Netherlands.,3Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- 1Arthritis Center Twente, Medisch Spectrum Twente, University of Twente, Enschede, The Netherlands.,Transparency in Healthcare b.v., Hengelo, The Netherlands.,3Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands.,4Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
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Brinkmann GH, Norvang V, Norli ES, Grøvle L, Haugen AJ, Lexberg ÅS, Rødevand E, Bakland G, Nygaard H, Krøll F, Widding-Hansen IJ, Bjørneboe O, Thunem C, Kvien T, Mjaavatten MD, Lie E. Treat to target strategy in early rheumatoid arthritis versus routine care – A comparative clinical practice study. Semin Arthritis Rheum 2019; 48:808-814. [DOI: 10.1016/j.semarthrit.2018.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022]
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18
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Lynde CW, Beecker J, Dutz J, Flanagan C, Guenther LC, Gulliver W, Papp K, Rahman P, Sholter D, Searles GE. Treating to Target(s) With Interleukin-17 Inhibitors. J Cutan Med Surg 2019; 23:3S-34S. [DOI: 10.1177/1203475418824565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
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Affiliation(s)
- Charles W. Lynde
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Probity Medical Research, Markham, ON, Canada
| | - Jennifer Beecker
- The Ottawa Hospital, ON, Canada
- The University of Ottawa, ON, Canada
- Probity Medical Research, Ottawa, ON, Canada
| | - Jan Dutz
- University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Wayne Gulliver
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - Proton Rahman
- Memorial University of Newfoundland, St. John’s, NL, Canada
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Steunebrink LMM, Versteeg LGA, Vonkeman HE, Ten Klooster PM, Hoekstra M, van de Laar MAFJ. Radiographic progression in early rheumatoid arthritis patients following initial combination versus step-up treat-to-target therapy in daily clinical practice: results from the DREAM registry. BMC Rheumatol 2018; 2:1. [PMID: 30886952 PMCID: PMC6390778 DOI: 10.1186/s41927-018-0009-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 02/08/2023] Open
Abstract
Background Early and intensive targeted treatment with disease modifying anti-rheumatic drugs (DMARDs) has been shown to lead to substantial reductions in disease activity and radiograph damage in patients with early rheumatoid arthritis (RA). The aim of this quasi-experimental study was to compare the first-year radiographic progression rates between a treat-to-target (T2 T) strategy with initial combination therapy (strategy II, started in 2012) versus an initial step-up monotherapy (strategy I, started in 2006). Methods A total of 128 patients from strategy II was individually matched with 128 patients from strategy I on sex, age (± 5 yrs.) and baseline disease activity (± 0.5 on the DAS28). Differences in radiographic progression (Sharp/van der Heijde) scores (SHS) and the number of patients experiencing a minimal clinically important difference (MCID; ≥ 5 SHS points) between both strategies were tested with Mann Whitney U and chi-square tests. Next, linear and logistic regression analyses were performed to examine which baseline variables were associated with radiographic progression scores and the probability of experiencing an MCID within 1 year. Results Patients with initial combination therapy had slightly higher baseline disease activity scores and pain scores, but better mental health scores. Patients with initial monotherapy had significantly more, and more frequently clinically relevant, radiographic progression after 1 year. Experiencing a MCID was independently associated with fewer tender joints (p = 0.050) and higher erythrocyte sedimentation rate (p = 0.015) at baseline. Conclusion Treating early RA patients with initial combination therapy results in better radiographic outcomes than initial monotherapy in daily clinical practice. Trial registration Netherlands Trial Register NTR578, 12 January 2006.
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Affiliation(s)
- Laura M M Steunebrink
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Letty G A Versteeg
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- 2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Mart A F J van de Laar
- 1Arthritis Center Twente, Department of Rheumatology, Medisch Spectrum Twente, PO BOX 50 000, 7500 KA Enschede, The Netherlands.,2Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
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20
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McQueen FM, Chapman P, Pollock T, D'Souza D, Lee AC, Dalbeth N, Stamp L, Lindsay K, Doyle A. Changes in clinical disease activity are weakly linked to changes in MRI inflammation on treat-to-target escalation of therapy in rheumatoid arthritis. Arthritis Res Ther 2017; 19:241. [PMID: 29065903 PMCID: PMC5655857 DOI: 10.1186/s13075-017-1433-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 02/04/2023] Open
Abstract
Background Rheumatoid arthritis (RA) treat-to-target (T2T) regimens often use the disease activity score (28 joints) incorporating C-reactive protein (DAS28CRP) as an outcome measure. We compared changes in the DAS28CRP with changes in magnetic resonance imaging (MRI) inflammation on treatment escalation. Methods Eighty seropositive RA patients with active disease were enrolled. Group A (N = 57) escalated to another conventional disease-modifying therapy (cDMARD) combination, and Group B (N = 23) to anti-TNF therapy/cDMARDs. Contrast-enhanced 3T-MRI wrist scans were obtained before and 4 months after regimen change. Scan pairs were scored for inflammation (MRI(i)) and damage. Disease activity was assessed using the DAS28CRP. Results Eighty patients were enrolled and 66 MRI scan pairs were available for analysis. Intra-reader reliability was high: intraclass correlation coefficient (average) 0.89 (0.56–0.97). ΔDAS28CRP did not differ between groups: Group A, −0.94 (−3.30, 1.61); Group B, −1.53 (−3.59, 0.56) (p = 0.45). ΔMRI(i) also did not differ: Group A, 0 (−25, 10); Group B, −1 (−15, 28) (p = 0.12). Combining groups, ΔMRI(i) correlated weakly with ΔDAS28CRP (Spearman’s 0.36, p = 0.003). Using multiple linear regression analysis adjusting for confounders, ΔDAS28CRP was associated with ΔMRI(i) (p = 0.056). Of the individual MRI measures, only Δtenosynovitis correlated with ΔDAS28CRP (Spearman’s 0.33, p = 0.007). ΔMRI(i) was negatively associated with the MRI erosion score at entry (p = 0.0052). Conclusions We report the first study investigating the link between changes in clinical and imaging inflammation in a real-world RA cohort escalating to conventional and biologic DMARDs. The association was significant but relatively weak, suggesting that MRI targets cannot yet be advocated as outcomes for T2T escalation. Trial registration ANZCTR 12614000895684. Registered 22 August 2014.
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Affiliation(s)
- Fiona M McQueen
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand. .,Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, 214 Green Lane West, Epsom, Auckland, 1051, New Zealand.
| | - Peter Chapman
- Department of Rheumatology, Immunology & Allergy, Christchurch Hospital, PO Box 4710, Christchurch, 8140, New Zealand
| | - Terina Pollock
- Department of Radiology, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Dena D'Souza
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Arier C Lee
- Section of Epidemiology & Biostatistics, School of Population Health (Tamaki Campus), University of Auckland, Auckland, 1142, New Zealand
| | - Nicola Dalbeth
- Bone & Joint Research Group, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand.,Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, 214 Green Lane West, Epsom, Auckland, 1051, New Zealand
| | - Lisa Stamp
- Department of Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Karen Lindsay
- Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, 214 Green Lane West, Epsom, Auckland, 1051, New Zealand
| | - Anthony Doyle
- Department of Radiology, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand
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Standardizing and personalizing the treat to target (T2T) approach for rheumatoid arthritis using the Patient-Reported Outcomes Measurement Information System (PROMIS): baseline findings on patient-centered treatment priorities. Clin Rheumatol 2017; 36:1729-1736. [DOI: 10.1007/s10067-017-3731-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 01/13/2023]
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