1
|
Møller-Bisgaard S, Hørslev-Petersen K, Ørnbjerg LM, Ejbjerg B, Hetland ML, Møller JM, Nielsen SM, Glinatsi D, Boesen M, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Hendricks O, Lindegaard H, Krogh NS, Jurik AG, Thomsen H, Christensen R, Østergaard M. Long-term efficacy of a 2-year MRI treat-to-target strategy on disease activity and radiographic progression in patients with rheumatoid arthritis in clinical remission: 5-year follow-up of the IMAGINE-RA randomised trial. RMD Open 2024; 10:e003945. [PMID: 38490697 PMCID: PMC10946351 DOI: 10.1136/rmdopen-2023-003945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To investigate whether a 2-year MRI treat-to-target strategy targeting the absence of osteitis combined with clinical remission, compared with a conventional treat-to-target strategy targeting clinical remission only (IMAGINE-rheumatoid arthritis (RA) trial) improves clinical and radiographic outcomes over 5 years in patients with RA in clinical remission. METHODS IMAGINE-more was an observational extension study of the original 2-year IMAGINE-RA randomised trial (NCT01656278). Clinical examinations and radiographs (hands and feet) were obtained yearly. Prespecified coprimary outcomes at year 5 were Disease Activity Score in 28 joints C reactive protein (DAS28-CRP) remission rate (DAS28-CRP<2.6) and no radiographic progression (van der Heijde-modified Sharp score (vdHSS) ≤0) from baseline. Secondary outcomes included 5-year changes in radiographic, MRI and clinical measures of disease activity and physical function. RESULTS In total 131 patients, 86 women (67%), mean age 61.2, disease duration 9.5 years, median baseline DAS28-CRP 1.9 (IQR 1.6-2.2) and vdHSS 16.0 (IQR 7.0-36.0) were included in the study; 59 (59%) patients from the original MRI treat-to-target group and 72 (72%) from the conventional group. At year 5, 47 patients (80%) in the MRI treat-to-target group vs 54 patients (75%) in the conventional treat-to-target group were in DAS28-CRP remission (OR 2.00 (95% CI 0.76 to 5.28); p=0.16) while 14 patients (24%) vs 19 patients (26%) had no radiographic progression (OR 0.70, (95% CI 0.28 to 1.71); p=0.43). CONCLUSION A 2-year combined MRI and clinical treat-to-target strategy, compared with a conventional clinical treat-to-target strategy alone, had no effect on the long-term probability of achieving DAS28-CRP remission and of avoiding radiographic progression.
Collapse
Affiliation(s)
- Signe Møller-Bisgaard
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Kim Hørslev-Petersen
- Department of Rheumatology, Sønderborg Sygehus, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Bo Ejbjerg
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Daniel Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Rheumatology, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Mikael Boesen
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Kristian Stengaard-Pedersen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology, Gentofte University Hospital, Hellerup, Denmark
| | - Bente Jensen
- Department of Rheumatology, Frederiksberg University Hospital, Frederiksberg, Denmark
| | | | - Ellen Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Oliver Hendricks
- Department of Rheumatology, Sønderborg Sygehus, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Thomsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| |
Collapse
|
2
|
Tornero Molina J, Hernández-Cruz B, Corominas H. Initial Treatment with Biological Therapy in Rheumatoid Arthritis. J Clin Med 2023; 13:48. [PMID: 38202055 PMCID: PMC10779475 DOI: 10.3390/jcm13010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND We aimed to analyse the effectiveness, efficiency, and safety of initial treatment with biological therapies in rheumatoid arthritis (RA). METHODS Qualitative study. A group of RA experts was selected. A scoping review in Medline was conducted to analyse the evidence of initial RA treatment with biological therapies. Randomised clinical trials were selected. Two reviewers analysed the articles and compiled the data, whose quality was assessed using the Jadad scale. The experts discussed the review's findings and generated a series of general principles: Results: Seventeen studies were included. Most of the included patients were middle-aged women with early RA (1-7 months) and multiple poor prognostic factors. Initial treatment with TNF-alpha inhibitors combined with methotrexate (MTX) and an IL6R inhibitor (either in mono or combination therapy) is effective (activity, function, radiographic damage, quality of life), safe, and superior to MTX monotherapy in the short and medium term. In the long term, patients who received initial treatment with biologicals presented better results than those whose initial therapy was with MTX. CONCLUSIONS Initial treatment of RA with biological therapies is effective, efficient, and safe in the short, medium, and long term, particularly for patients with poor prognostic factors.
Collapse
Affiliation(s)
- Jesús Tornero Molina
- Departamento de Reumatología, Hospital de Guadalajara, 19002 Guadalajara, Spain
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, 28805 Madrid, Spain
| | - Blanca Hernández-Cruz
- Departamento de Reumatología, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | - Héctor Corominas
- Departamento de Reumatología, Hospital Universitari de Sant Pau & Hospital Dos de Maig, 08025 Barcelona, Spain;
- Medicine Faculty, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| |
Collapse
|
3
|
van Esveld L, Cox JM, Kuijper TM, Bosch TM, Weel-Koenders AE. Cost-utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands. Ann Rheum Dis 2023; 82:1296-1306. [PMID: 37423648 DOI: 10.1136/ard-2023-224190] [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: 03/23/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Current guidelines recommend tapering biological disease-modifying antirheumatoid drugs (bDMARDs) in rheumatoid arthritis (RA) if the disease is under control. However, guidelines on tapering are lacking. Assessing cost-effectiveness of different tapering strategies might provide broader input for creating guidelines on how to taper bDMARDs in patients with RA. The aim of this study is to evaluate the long-term cost-effectiveness from a societal perspective of bDMARD tapering strategies in Dutch patients with RA, namely 50% dose reduction (tapering), discontinuation and a 50% dose reduction followed by discontinuation (de-escalation). METHODS Using a societal perspective, a Markov model with a life-time horizon of 30 years was used to simulate 3-monthly transitions between Disease Activity 28 (DAS28)-defined health states of remission (<2.6), low disease activity (2.63.2). Transition probabilities were estimated through literature search and random effects pooling. Incremental costs, incremental quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits for each tapering strategy were compared with continuation. Deterministic, probabilistic sensitivity analyses and multiple scenario analyses were performed. RESULTS After 30 years, the ICERs were €115 157/QALY lost, €74 226/QALY lost and €67 137/QALY lost for tapering, de-escalation and discontinuation, respectively; mainly driven by bDMARD cost savings and a 72.8% probability of a loss in quality of life. This corresponds to a 76.1%, 64.3% and 60.1% probability of tapering, de-escalation and discontinuation being cost-effective, provided a willingness-to-accept threshold of €50 000/QALY lost. CONCLUSIONS Based on these analyses, the 50% tapering approach saved the highest cost per QALY lost.
Collapse
Affiliation(s)
| | - Juul M Cox
- Hospital Pharmacy, Maasstad Hospital, Rotterdam, The Netherlands
- Clinical Pharmacology and Toxicology, MaasstadLab Maasstad Hospital, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Tessa M Bosch
- Hospital Pharmacy, Maasstad Hospital, Rotterdam, The Netherlands
- Clinical Pharmacology and Toxicology, MaasstadLab Maasstad Hospital, Rotterdam, The Netherlands
| | - Angelique Eam Weel-Koenders
- Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Westerlind H, Glintborg B, Hammer HB, Saevarsdottir S, Krogh NS, Hetland ML, Hauge EM, Martinez Tejada I, Sexton J, Askling J. Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts. RMD Open 2023; 9:e003027. [PMID: 37673441 PMCID: PMC10496677 DOI: 10.1136/rmdopen-2023-003027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE Precision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study cohorts can be achieved and investigate how the observed proportions reaching remission vary across remission criteria, study types, disease-modifying antirheumatic drugs (DMARDs) and countries, and how they relate to other treatment outcomes. METHODS We used data from eight existing large-scale, clinical RA registers and a pragmatic trial from Sweden, Denmark and Norway. In these, we defined three types of treatment cohorts; methotrexate monotherapy (as first DMARD), tumour necrosis factor inhibitors (TNFi) (as first biological DMARD) and rituximab. We developed a harmonised study protocol defining time points during 36 months of follow-up, collected clinical visit data on treatment response, retention, persistence and six alternative definitions of remission, and investigated how these outcomes differed within and between cohorts, by treatment. RESULTS Cohort sizes ranged from ~50 to 22 000 patients with RA. The proportions reaching each outcome varied across outcome metric, but with small to modest variations within and between cohorts, countries and treatment. Retention and persistence rates were high (>50% at 1 year), yet <33% of patients starting methotrexate or TNFi, and only 10% starting rituximab, remained on drug without other DMARDs added and achieved American Congress of Rheumatology/European Alliance of Associations for Rheumatology or Simplified Disease Activity Index remission at 1 year. CONCLUSION Harmonisation of data from different RA data sources can be achieved without compromising internal validity or generalisability. The low proportions reaching remission, point to an unmet need for treatment optimisation in RA.
Collapse
Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bente Glintborg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Hilde Berner Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Saedis Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Niels Steen Krogh
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Merete Lund Hetland
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Isabel Martinez Tejada
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Pedersen JM, Hansen AS, Skejø C, Juul-Madsen K, Junker P, Hørslev-Petersen K, Hetland ML, Stengaard-Pedersen K, Østergaard M, Møller BK, Dreyer L, Hauge EM, Hvid M, Greisen S, Deleuran B. Lymphocyte activation gene 3 is increased and affects cytokine production in rheumatoid arthritis. Arthritis Res Ther 2023; 25:97. [PMID: 37287025 DOI: 10.1186/s13075-023-03073-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/20/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Lymphocyte activation gene-3 (LAG-3) inhibits T cell activation and interferes with the immune response by binding to MHC-II. As antigen presentation is central in rheumatoid arthritis (RA) pathogenesis, we studied aspects of LAG-3 as a serological marker and mediator in the pathogenesis of RA. Since Galectin-3 (Gal-3) is described as an additional binding partner for LAG-3, we also aimed to study the functional importance of this interaction. METHODS Plasma levels of soluble (s) LAG-3 were measured in early RA patients (eRA, n = 99) at baseline and after 12 months on a treat-to-target protocol, in self-reportedly healthy controls (HC, n = 32), and in paired plasma and synovial fluid (SF) from chronic RA patients (cRA, n = 38). Peripheral blood mononuclear cells (PBMCs) and synovial fluid mononuclear cells (SFMCs) were examined for LAG-3 expression by flow cytometry. The binding and functional outcomes of LAG-3 and Gal-3 interaction were assessed with surface plasmon resonance (SPR) and in cell cultures using rh-LAG3, an antagonistic LAG-3 antibody and a Gal-3 inhibitor. RESULTS Baseline sLAG-3 in the plasma was increased in eRA compared to HC and remained significantly elevated throughout 12 months of treatment. A high level of sLAG-3 at baseline was associated with the presence of IgM-RF and anti-CCP as well as radiographic progression. In cRA, sLAG-3 was significantly increased in SF compared with plasma, and LAG-3 was primarily expressed by activated T cells in SFMCs compared to PBMCs. Adding recombinant human LAG-3 to RA cell cultures resulted in decreased cytokine secretion, whereas blocking LAG-3 with an antagonistic antibody resulted in increased cytokine secretion. By SPR, we found a dose-dependent binding between LAG-3 and Gal-3. However, inhibiting Gal-3 in cultures did not further change cytokine production. CONCLUSIONS sLAG-3 in the plasma and synovial fluid is increased in both early and chronic RA patients, particularly in the inflamed joint. High levels of sLAG-3 are associated with autoantibody seropositivity and radiographic progression in eRA, and LAG-3 plays a biologically active role in cRA by decreasing inflammatory cytokine production. This functional outcome is not affected by Gal-3 interference. Our results suggest that LAG-3 is a faceted regulator of inflammation in early and chronic RA.
Collapse
Affiliation(s)
- Janni Maria Pedersen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark.
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark.
| | - Aida Solhøj Hansen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
| | - Cæcilie Skejø
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
| | - Kristian Juul-Madsen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
| | - Peter Junker
- Department of Rheumatology C, Odense University Hospital & Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kim Hørslev-Petersen
- Danish Hospital for the Rheumatic Diseases, University of Southern Denmark, Odense, Denmark
| | - Merete Lund Hetland
- DANBIO and Copenhagen Centre for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | | | - Mikkel Østergaard
- DANBIO and Copenhagen Centre for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bjarne Kuno Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Dreyer
- Center for Rheumatic Research Aalborg, Department of Rheumatology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Hvid
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stinne Greisen
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Deleuran
- Department of Biomedicine, Aarhus University, C.F. Møllers Alle 6, 8000, Aarhus C, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
6
|
Messelink MA, den Broeder AA, Marinelli FE, Michgels E, Verschueren P, Aletaha D, Tekstra J, Welsing PMJ. What is the best target in a treat-to-target strategy in rheumatoid arthritis? Results from a systematic review and meta-regression analysis. RMD Open 2023; 9:rmdopen-2023-003196. [PMID: 37116986 PMCID: PMC10152050 DOI: 10.1136/rmdopen-2023-003196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES A treat-to-target (T2T) strategy has been shown to be superior to usual care in rheumatoid arthritis (RA), but the optimal target remains unknown. Targets are based on a disease activity measure (eg, Disease Activity Score-28 (DAS28), Simplified Disease Activity Indices/Clinical Disease Activity Indices (SDAI/CDAI), and a cut-off such as remission or low disease activity (LDA). Our aim was to compare the effect of different targets on clinical and radiographic outcomes. METHODS Cochrane, Embase and (pre)MEDLINE databases were searched (1 June 2022) for randomised controlled trials and cohort studies after 2003 that applied T2T in RA patients for ≥12 months. Data were extracted from individual T2T study arms; risk of bias was assessed with the Cochrane Collaboration tool. Using meta-regression, we evaluated the effect of the target used on clinical and radiographic outcomes, correcting for heterogeneity between and within studies. RESULTS 115 treatment arms were used in the meta-regression analyses. Aiming for SDAI/CDAI-LDA was statistically superior to targeting DAS-LDA regarding DAS-remission and SDAI/CDAI/Boolean-remission outcomes over 1-3 years. Aiming for SDAI/CDAI-LDA was also significantly superior to DAS-remission regarding both SDAI/CDAI/Boolean-remission (over 1-3 years) and mean SDAI/CDAI (over 1 year). Targeting DAS-remission rather than DAS-LDA only improved the percentage of patients in DAS-remission, and only statistically significantly after 2-3 years of T2T. No differences were observed in Health Assessment Questionnaire and radiographic progression. CONCLUSIONS Targeting SDAI/CDAI-LDA, and to a lesser extent DAS-remission, may be superior to targeting DAS-LDA regarding several clinical outcomes. However, due to the risk of residual confounding and the lack of data on (over)treatment and safety, future studies should aim to directly and comprehensively compare targets. PROSPERO REGISTRATION NUMBER CRD42021249015.
Collapse
Affiliation(s)
| | | | | | - Edwin Michgels
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - P Verschueren
- Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Janneke Tekstra
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Paco M J Welsing
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| |
Collapse
|
7
|
Increased Galectin-9 Levels Correlate with Disease Activity in Patients with DMARD-Naïve Rheumatoid Arthritis and Modulate the Secretion of MCP-1 and IL-6 from Synovial Fibroblasts. Cells 2023; 12:cells12020327. [PMID: 36672263 PMCID: PMC9857341 DOI: 10.3390/cells12020327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Background: Fibroblast-like synoviocytes (FLSs) are essential mediators in the expansive growth and invasiveness of rheumatoid synovitis, and patients with a fibroblastic-rich pauci-immune pathotype respond poorly to currently approved antirheumatic drugs. Galectin-9 (Gal-9) has been reported to directly modulate rheumatoid arthritis (RA) FLSs and to hold both pro- and anti-inflammatory properties. The objective of this study was to evaluate clinical and pathogenic aspects of Gal-9 in RA, combining national patient cohorts and cellular models. Methods: Soluble Gal-9 was measured in plasma from patients with newly diagnosed, treatment-naïve RA (n = 98). The disease activity score 28-joint count C-reactive protein (DAS28CRP) and total Sharp score were used to evaluate the disease course serially over a two-year period. Plasma and synovial fluid samples were examined for soluble Gal-9 in patients with established RA (n = 18). A protein array was established to identify Gal-9 binding partners in the extracellular matrix (ECM). Synovial fluid mononuclear cells (SFMCs), harvested from RA patients, were used to obtain synovial-fluid derived FLSs (SF-FLSs) (n = 7). FLSs from patients suffering from knee Osteoarthritis (OA) were collected from patients when undergoing joint replacement surgery (n = 5). Monocultures of SF-FLSs (n = 6) and autologous co-cultures of SF-FLSs and peripheral blood mononuclear cells (PBMCs) were cultured with and without a neutralizing anti-Gal-9 antibody (n = 7). The mono- and co-cultures were subsequently analyzed by flow cytometry, MTT assay, and ELISA. Results: Patients with early and established RA had persistently increased plasma levels of Gal-9 compared with healthy controls (HC). The plasma levels of Gal-9 were associated with disease activity and remained unaffected when adding a TNF-inhibitor to their standard treatment. Gal-9 levels were elevated in the synovial fluid of established RA patients with advanced disease, compared with corresponding plasma samples. Gal-9 adhered to fibronectin, laminin and thrombospondin, while not to interstitial collagens in the ECM protein array. In vitro, a neutralizing Gal-9 antibody decreased MCP-1 and IL-6 production from both RA FLSs and OA FLSs. In co-cultures of autologous RA FLSs and PBMCs, the neutralization of Gal-9 also decreased MCP-1 and IL-6 production, without affecting the proportion of inflammatory FLSs. Conclusions: In RA, pretreatment plasma Gal-9 levels in early RA were increased and correlated with clinical disease activity. Gal-9 levels remained increased despite a significant reduction in the disease activity score in patients with early RA. The in vitro neutralization of Gal-9 decreased both MCP-1 and IL-6 production in an inflammatory subset of RA FLSs. Collectively these findings indicate that the persistent overexpression of Gal-9 in RA may modulate synovial FLS activities and could be involved in the maintenance of subclinical disease activity in RA.
Collapse
|
8
|
Nielsen MA, Køster D, Greisen S, Troldborg A, Stengaard-Pedersen K, Junker P, Hørslev-Petersen K, Hetland ML, Østergaard M, Hvid M, Leffler H, Kragstrup TW, Deleuran B. Increased synovial galectin-3 induce inflammatory fibroblast activation and osteoclastogenesis in patients with rheumatoid arthritis. Scand J Rheumatol 2023; 52:33-41. [PMID: 35023445 DOI: 10.1080/03009742.2021.1992860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Galectin-3 (Gal-3) has been suggested as a proinflammatory mediator in rheumatoid arthritis (RA). We aimed to study clinical and pathogenic aspects of Gal-3 in RA. METHOD Plasma samples from healthy controls (n = 48) and patients with newly diagnosed, early RA were assayed for soluble Gal-3. In patients with chronic RA (n = 18), Gal-3 was measured in both plasma and synovial fluid. Synovial fluid mononuclear cells were used to purify fibroblast-like synoviocytes (FLSs) and osteoclasts. Monocultures of FLSs and autologous co-cultures of FLSs and peripheral blood mononuclear cells were established and co-incubated with a Gal-3 inhibitor. RESULTS Patients with early and chronic RA had persistently increased plasma levels of Gal-3 compared with controls. However, changes in plasma Gal-3 at the level of individuals were associated with long-term disease activity. In seropositive early RA patients, all patients with decreasing plasma Gal-3 from 0 to 3 months had low disease activity after 2 years (p < 0.05). Gal-3 levels in synovial fluid were markedly elevated. In vitro, co-incubation with a Gal-3 inhibitor (GB1107, 10 µM) led to a significant reduction in both interleukin-1β and tumour necrosis factor-α secretion from FLS monocultures (both p < 0.05) and decreased monocyte-derived osteoclastogenesis compared with controls (both p < 0.05). CONCLUSIONS Our findings underscore the role of Gal-3 regarding disease activity and tissue destruction in RA. An initial decrease in plasma Gal-3 levels predicted decreased long-term disease activity. Correspondingly, a Gal-3 inhibitor decreased the activity of inflammatory FLSs and osteoclastogenesis in patients with RA.
Collapse
Affiliation(s)
- M A Nielsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - D Køster
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - S Greisen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Troldborg
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - P Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - K Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Odense, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
| | - M Hvid
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - H Leffler
- Immunology and Glycobiology (MIG), Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - T W Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - B Deleuran
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Kolan SS, Li G, Grimolizzi F, Sexton J, Goll G, Kvien TK, Sundlisæter NP, Zucknick M, Lillegraven S, Haavardsholm EA, Skålhegg BS. Identification of SNPs associated with methotrexate treatment outcomes in patients with early rheumatoid arthritis. Front Pharmacol 2022; 13:1075603. [DOI: 10.3389/fphar.2022.1075603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Methotrexate is one of the cornerstones of rheumatoid arthritis (RA) therapy. Genetic factors or single nucleotide polymorphisms (SNPs) are responsible for 15%–30% of the variation in drug response. Identification of clinically effective SNP biomarkers for predicting methotrexate (MTX) sensitivity has been a challenge. The aim of this study was to explore the association between the disease related outcome of MTX treatment and 23 SNPs in 8 genes of the MTX pathway, as well as one pro-inflammatory related gene in RA patients naïve to MTX. Categorical outcomes such as Disease Activity Score (DAS)-based European Alliance of Associations for Rheumatology (EULAR) non-response at 4 months, The American College of Rheumatology and EULAR (ACR/EULAR) non-remission at 6 months, and failure to sustain MTX monotherapy from 12 to 24 months were assessed, together with continuous outcomes of disease activity, joint pain and fatigue. We found that the SNPs rs1801394 in the MTRR gene, rs408626 in DHFR gene, and rs2259571 in AIF-1 gene were significantly associated with disease activity relevant continuous outcomes. Additionally, SNP rs1801133 in the MTHFR gene was identified to be associated with improved fatigue. Moreover, associations with p values at uncorrected significance level were found in SNPs and different categorical outcomes: 1) rs1476413 in the MTHFR gene and rs3784864 in ABCC1 gene are associated with ACR/EULAR non-remission; 2) rs1801133 in the MTHFR gene is associated with EULAR response; 3) rs246240 in the ABCC1 gene, rs2259571 in the AIF-1 gene, rs2274808 in the SLC19A1 gene and rs1476413 in the MTHFR gene are associated with failure to MTX monotherapy after 12–24 months. The results suggest that SNPs in genes associated with MTX activity may be used to predict MTX relevant-clinical outcomes in patients with RA.
Collapse
|
10
|
miRNA-Mediated Epigenetic Regulation of Treatment Response in RA Patients—A Systematic Review. Int J Mol Sci 2022; 23:ijms232112989. [PMID: 36361779 PMCID: PMC9657910 DOI: 10.3390/ijms232112989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to evaluate the role of microRNAs (miRNA) as biomarkers of treatment response in rheumatoid arthritis (RA) patients through a systematic review of the literature. The MEDLINE and Embase databases were searched for studies including RA-diagnosed patients treated with disease-modifying antirheumatic drugs (DMARDs) that identify miRNAs as response predictors. Review inclusion criteria were met by 10 studies. The main outcome of the study was the response to treatment, defined according to EULAR criteria. A total of 839 RA patients and 67 healthy donors were included in the selected studies. RA patients presented seropositivity for the rheumatoid factor of 74.7% and anti-citrullinated C-peptide antibodies of 63.6%. After revision, 15 miRNAs were described as treatment response biomarkers for methotrexate, anti-tumour necrosis factor (TNF), and rituximab. Among treatments, methotrexate presented the highest number of predictor miRNAs: miR-16, miR-22, miR-132, miR-146a and miR-155. The most polyvalent miRNAs were miR-146a, predicting response to methotrexate and anti-TNF, and miR-125b, which predicts response to infliximab and rituximab. Our data support the role of miRNAs as biomarkers of treatment response in RA and point to DMARDs modifying the miRNAs expression. Nevertheless, further studies are needed since a meta-analysis that allows definitive conclusions is not possible due to the lack of studies in this field.
Collapse
|
11
|
Raft MB, Hetland ML, Brahe CH, Hørslev-Petersen K, Midtbøll Ørnbjerg L, Junker P, Biln N, Stengaard-Pedersen K, Østergaard M. Serum 14-3-3η as predictor of clinical remission and progression of structural damage in early rheumatoid arthritis following a treat-to-target strategy in a randomized controlled trial. Scand J Rheumatol 2022:1-11. [PMID: 35833274 DOI: 10.1080/03009742.2022.2087900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE 14-3-3η is a proinflammatory mediator critical to joint destruction in rheumatoid arthritis (RA). We aimed to evaluate serum 14-3-3η for predicting disease activity and radiographic progression in patients with early RA in the double-blinded, randomized OPERA trial. METHOD 180 patients with early RA were randomized to receive methotrexate (MTX) + adalimumab or MTX + placebo in combination with glucocorticoid injections into swollen joints. Disease activity was measured using the 28-joint Disease Activity Score-C-reactive protein (DAS28-CRP). Clinical remission was defined as DAS28-CRP < 2.6. X-rays of hands and feet were evaluated by the Total Sharp van der Heijde score (TSS). Radiographic progression was defined as exceeding the smallest detectable change (1.8 TSS-units). Serum 14-3-3η was determined by enzyme-linked immunosorbent assay. Multivariate logistic regression models were used to identify predictors of DAS28-CRP remission at 6 months and radiographic progression at 12 months. RESULTS Baseline 14-3-3η was a borderline significant independent predictor of radiographic progression at 12 months (odds radio = 1.02, 95% confidence interval 1.00-1.03, p = 0.05). In anti-cyclic citrullinated peptide antibody (ACPA)-negative patients, a moderate/high baseline 14-3-3η concentration increased the risk of radiographic progression at 12 months [4/51 (8%) vs 3/9 (33%), χ2 = 4.823, p = 0.028]. No value of 14-3-3η for predicting achievement of clinical remission was found. CONCLUSION Serum 14-3-3η was a borderline significant predictor of radiographic progression, particularly in ACPA-negative patients, but not of predicting achievement of clinical remission. Optimal cut-off levels of 14-3-3η for predicting radiographic progression in RA need further clarification.
Collapse
Affiliation(s)
- M B Raft
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The DANBIO Registry, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - C H Brahe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - K Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - L Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - P Junker
- Department of Rheumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Denmark
| | - N Biln
- Augurex Life Sciences Corp, Vancouver, British Columbia, Canada
| | | | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
He B, Li Y, Luo WW, Cheng X, Xiang HR, Zhang QZ, He J, Peng WX. The Risk of Adverse Effects of TNF-α Inhibitors in Patients With Rheumatoid Arthritis: A Network Meta-Analysis. Front Immunol 2022; 13:814429. [PMID: 35250992 PMCID: PMC8888889 DOI: 10.3389/fimmu.2022.814429] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/24/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives To evaluate the safety of each anti-TNF therapy for patients with rheumatoid arthritis (RA) and then make the best choice in clinical practice. Methods We searched PUBMED, EMBASE, and the Cochrane Library. The deadline for retrieval is August 2021. The ORs, Confidence Intervals (CIs), and p values were calculated by STATA.16.0 software for assessment. Result 72 RCTs involving 28332 subjects were included. AEs were more common with adalimumab combined disease-modifying anti-rheumatic drugs (DMARDs) compared with placebo (OR = 1.60, 95% CI: 1.06, 2.42), DMARDs (1.28, 95% CI: 1.08, 1.52), etanercept combined DMARDs (1.32, 95% CI: 1.03, 1.67); certolizumab combined DMARDs compared with placebo (1.63, 95% CI: 1.07, 2.46), DMARDs (1.30, 95% CI: 1.10, 1.54), etanercept combined DMARDs (1.34, 95% CI: 1.05, 1.70). In SAEs, comparisons between treatments showed adalimumab (0.20, 95% CI: 0.07, 0.59), etanercept combined DMARDs (0.39, 95% CI: 0.15, 0.96), golimumab (0.19, 95% CI: 0.05, 0.77), infliximab (0.15, 95% CI: 0.03,0.71) decreased the risk of SAEs compared with golimumab combined DMARDs. In infections, comparisons between treatments showed adalimumab combined DMARDs (0.59, 95% CI: 0.37, 0.95), etanercept (0.49, 95% CI: 0.28, 0.88), etanercept combined DMARDs (0.56, 95% CI: 0.35, 0.91), golimumab combined DMARDs (0.51, 95% CI: 0.31, 0.83) decreased the risk of infections compared with infliximab combined DMARDs. No evidence indicated that the use of TNF-α inhibitors influenced the risk of serious infections, malignant tumors. Conclusion In conclusion, we regard etanercept monotherapy as the optimal choice for RA patients in clinical practice when the efficacy is similar. Conversely, certolizumab + DMARDs therapy is not recommended. Systematic Review Registration identifier PROSPERO CRD42021276176.
Collapse
Affiliation(s)
- Bei He
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yun Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Wen Luo
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huai-Rong Xiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qi-Zhi Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jie He
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Xing Peng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| |
Collapse
|
13
|
Greisen SR, Kragstrup TW, Thomsen JS, Hørslev-Pedersen K, Hetland ML, Stengaard-Pedersen K, Østergaard M, Ørnbjerg L, Junker P, Sharpe AH, Freeman GJ, Hvid M, Moestrup SK, Hauge EM, Deleuran B. The Programmed Death-1 Pathway Counter-Regulates Inflammation-Induced Osteoclast Activity in Clinical and Experimental Settings. Front Immunol 2022; 13:773946. [PMID: 35356000 PMCID: PMC8959817 DOI: 10.3389/fimmu.2022.773946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/04/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The programmed death-1 (PD-1) pathway is essential for maintaining self-tolerance and plays an important role in autoimmunity, including rheumatoid arthritis (RA). Here, we investigated how membrane-bound and soluble (s)PD-1 influence bone homeostasis during chronic inflammation, exemplified in RA. Methods Bone mineral density and bone microstructure were examined in PD-1 and PD-L1 knockout (KO) mice and compared with wild-type (WT) mice. Receptor activator of nuclear factor kappa-B ligand (RANKL) was measured in serum, and the expression examined on activated bone marrow cells. Osteoclast formation was examined in cells from murine spleen and bone marrow and from human synovial fluid cells. sPD-1 was measured in chronic and early (e)RA patients and correlated to markers of disease activity and radiographic scores. Results PD-1 and PD-L1 KO mice showed signs of osteoporosis. This was supported by a significantly reduced trabecular bone volume fraction and deteriorated microstructure, as well as increased osteoclast formation and an increased RANKL/OPG ratio. The recombinant form of sPD-1 decreased osteoclast formation in vitro, but was closely associated with disease activity markers in eRA patients. Sustained elevated sPD-1 levels indicated ongoing inflammation and were associated with increased radiographic progression. Conclusion The PD-1 pathway is closely associated with bone homeostasis, and lacking members of this pathway causes a deteriorated bone structure. The immunological balance in the microenvironment determines how the PD-1 pathway regulates osteoclast formation. In eRA patients, sPD-1 may serve as a biomarker, reflecting residual but clinically silent disease activity and radiographic progression.
Collapse
Affiliation(s)
- Stinne R Greisen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology , Aarhus University Hospital, Aarhus, Denmark
| | - Tue W Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology , Aarhus University Hospital, Aarhus, Denmark
| | | | - Kim Hørslev-Pedersen
- Danish Hospital for the Rheumatic Diseases , and University of Southern Denmark, Sonderborg, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lykke Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Arlene H Sharpe
- Department of Immunology, Harvard Medical School, Boston, MA, United States
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Malene Hvid
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine , Aarhus University, Aarhus, Denmark
| | | | - Ellen Margrethe Hauge
- Department of Rheumatology , Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine , Aarhus University, Aarhus, Denmark
| | - Bent Deleuran
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology , Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
14
|
Kishimoto Y, Kato Y, Uemura M, Kuranobu K. Can Intra-articular Injection of Glucocorticoids Be an Alternative Intervention to Achieve Remission in Patients With Rheumatoid Arthritis Exhibiting Low Disease Activity? A Single-Center Longitudinal Study. J Clin Rheumatol 2022; 28:e353-e358. [PMID: 35192592 DOI: 10.1097/rhu.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE This study aimed at investigating whether a single intra-articular (IA) injection of triamcinolone acetonide (TA) could facilitate to achieve clinical remission in patients with rheumatoid arthritis (RA) exhibiting low disease activity (LDA). METHODS This longitudinal study included 22 patients with RA exhibiting LDA involving wrist arthritis at our institution between April 2016 and March 2019. A single IA injection of 20 mg TA was administered into the symptomatic wrist joint. Efficacy was assessed by the primary end point of proportion of patients reaching clinical remission. Secondary end points included Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire Disability Index, adverse events, and ultrasonographic assessment of the injected wrist joints. RESULTS Remission rates were 40% and 50% at weeks 4 and 12, respectively, and were maintained at approximately 50% until week 24. The secondary outcomes of CDAI, SDAI, and Health Assessment Questionnaire Disability Index were improved significantly at week 4, and the improvements in CDAI and SDAI continued up to week 24. Ultrasonography showed that synovial hypertrophy, power Doppler signals, and the combined score were significantly reduced at weeks 4, 12, and 24 compared with the baseline. No patient developed severe, irreversible adverse events. CONCLUSIONS Approximately half of the patients with RA exhibiting LDA who received a single IA injection of TA into the wrist joints achieved clinical remission without serious adverse events in the midterm period, suggesting that IA injection of TA might be considered as an alternative intervention to achieve remission in patients with RA exhibiting LDA.
Collapse
Affiliation(s)
| | | | | | - Koji Kuranobu
- Rehabilitation, Japanese Red Cross Tottori Hospital, Tottori, Japan
| |
Collapse
|
15
|
Greisen SR, Mikkelsen C, Hetland ML, Østergaard M, Hørslev-Petersen K, Junker P, Stengaard-Petersen K, Deleuran B. CXCL13 predicts long term radiographic status in early rheumatoid arthritis. Rheumatology (Oxford) 2021; 61:2590-2595. [PMID: 34636880 DOI: 10.1093/rheumatology/keab763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES It remains challenging to identify rheumatoid arthritis (RA) patients at a high risk of joint destruction. The C-X-C motif chemokine 13 (CXCL13) has previously been suggested as a marker of disease activity in RA. Here, we investigate the potential of plasma CXCL13 as a marker of long-term radiographic status and progression. METHODS CXCL13 was measured in plasma from treatment naïve RA patients (n = 158) with 11-year follow-up. At baseline, clinical and biochemical disease activity scores were obtained; among these C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disease activity score in 28 joints with CRP(DAS28CRP), number of, swollen joints (SJC28) and radiographic status, evaluated by total Sharp score (TSS). Age and gender matched healthy controls (HC) were included. RESULTS CXCL13 was significantly increased at baseline and decreased during treatment, however without reaching the level in HC. At baseline, CXCL13 was associated with both CRP and ESR, but not with other markers of disese activity. Baseline CXCL13 correlated with both TSS and radiographic progression (ΔTSS) at 11 years. With a 89% probability, levels of CXCL13 above 85 pg/ml predicted the risk of a TSS of 5 or above, after 11 years of treatment. Comparing with CRP, DAS28CRP, SJC28 and anti-citrullinated peptide antibody status, CXCL13 was superior in predicting 11-year joint destruction. CONCLUSION In early RA, one single measurement of plasma CXCL13 at baseline, is superior to currently used clinical and serological disease markers, to predict longterm radiographic status and progression.
Collapse
Affiliation(s)
- Stinne R Greisen
- Department of Biomedicine, Aarhus University
- Department of Rheumatology, Aarhus University Hospital, Aarhus
| | | | - Merete L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Kim Hørslev-Petersen
- Department of Rheumatology, Danish Hospital for the Rheumatic Diseases, and University of Southern Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Bent Deleuran
- Department of Biomedicine, Aarhus University
- Department of Rheumatology, Aarhus University Hospital, Aarhus
| |
Collapse
|
16
|
Adas MA, Allen VB, Yates M, Bechman K, Clarke BD, Russell MD, Rutherford AI, Cope AP, Norton S, Galloway JB. A systematic review and network meta-analysis of the safety of early interventional treatments in rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4450-4462. [PMID: 34003970 PMCID: PMC8487311 DOI: 10.1093/rheumatology/keab429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the safety of treatment strategies in patients with early RA. Methods Systematic searches of MEDLINE, EMBASE and PubMed were conducted up to September 2020. Double-blind randomized controlled trials (RCTs) of licensed treatments conducted on completely naïve or MTX-naïve RA patients were included. Long-term extension studies, post-hoc and pooled analyses and RCTs with no comparator arm were excluded. Serious adverse events, serious infections and non-serious adverse events were extracted from all RCTs, and event rates in intervention and comparator arms were compared using meta-analysis and network meta-analysis (NMA). Results From an initial search of 3423 studies, 20 were included, involving 9202 patients. From the meta-analysis, the pooled incidence rates per 1000 patient-years for serious adverse events were 69.8 (95% CI: 64.9, 74.8), serious infections 18.9 (95% CI: 16.2, 21.6) and non-serious adverse events 1048.2 (95% CI: 1027.5, 1068.9). NMA showed that serious adverse event rates were higher with biologic monotherapy than with MTX monotherapy, rate ratio 1.39 (95% CI: 1.12, 1.73). Biologic monotherapy rates were higher than those for MTX and steroid therapy, rate ratio 3.22 (95% CI: 1.47, 7.07). Biologic monotherapy had a higher adverse event rate than biologic combination therapy, rate ratio 1.26 (95% CI: 1.02, 1.54). NMA showed no significant difference between strategies with respect to serious infections and non-serious adverse events rates. Conclusion The study revealed the different risk profiles for various early RA treatment strategies. Observed differences were overall small, and in contrast to the findings of established RA studies, steroid-based regimens did not emerge as more harmful.
Collapse
Affiliation(s)
- Maryam A Adas
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Victoria B Allen
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Katie Bechman
- Centre for Rheumatic Diseases, King's College London, London, UK
| | | | - Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | | | - Andrew P Cope
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Sam Norton
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| |
Collapse
|
17
|
Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Christensen R, Ørnbjerg LM, Glinatsi D, Møller JM, Boesen M, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard H, Bliddal H, Krogh NS, Ellingsen T, Nielsen AH, Larsen L, Jurik AG, Thomsen HS, Østergaard M. Effect of initiating biologics compared to intensifying conventional DMARDs on clinical and MRI outcomes in established rheumatoid arthritis patients in clinical remission: Secondary analyses of the IMAGINE-RA trial. Scand J Rheumatol 2021; 51:268-278. [PMID: 34474649 DOI: 10.1080/03009742.2021.1935312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: To compare the effect of treat-to-target-based escalations in conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics on clinical disease activity and magnetic resonance imaging (MRI) inflammation in a rheumatoid arthritis (RA) cohort in clinical remission.Method: One-hundred patients with established RA, Disease Activity Score based on 28-joint count-C-reactive protein (DAS28-CRP) < 3.2, and no swollen joints (hereafter referred to as 'in clinical remission') who received csDMARDs underwent clinical evaluation and MRI of the wrist and second to fifth metacarpophalangeal joints every 4 months. They followed a 2 year MRI treatment strategy targeting DAS28-CRP ≤ 3.2, no swollen joints, and absence of MRI osteitis, with predefined algorithmic treatment escalation: first: increase in csDMARDs; second: adding a biologic; third: switch biologic. MRI osteitis and Health Assessment Questionnaire (HAQ) (co-primary outcomes) and MRI combined inflammation and Simplified Disease Activity Index (SDAI) (key secondary outcomes) were assessed 4 months after treatment change and expressed as estimates of group differences. Statistical analyses were based on the intention-to-treat population analysed using repeated-measures mixed models.Escalation to first biologic compared to csDMARD escalation more effectively reduced MRI osteitis (difference between least squares means 1.8, 95% confidence interval 1.0-2.6), HAQ score (0.08, 0.03-0.1), MRI combined inflammation (2.5, 0.9-4.1), and SDAI scores (2.7, 1.9-3.5).Treat-to-target-based treatment escalations to biologics compared to escalation in csDMARDs more effectively improved MRI inflammation, physical function, and clinical disease activity in patients with established RA in clinical remission. Treatment escalation in RA patients in clinical remission reduces clinical and MRI-assessed disease activity.Trial registration: Clinicaltrials.gov identifier: NCT01656278.
Collapse
Affiliation(s)
- S Møller-Bisgaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - K Hørslev-Petersen
- Department of Rheumatology, Sønderborg Sygehus, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - B Ejbjerg
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L M Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
| | - D Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - J M Møller
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - M Boesen
- Department of Radiology, Frederiksberg Hospital, Frederiksberg, Denmark
| | - K Stengaard-Pedersen
- Department of Rheumatology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - O R Madsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - B Jensen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - J A Villadsen
- Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - E M Hauge
- Department of Rheumatology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - P Bennett
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - O Hendricks
- Department of Rheumatology, Sønderborg Sygehus, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K Asmussen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - M Kowalski
- Department of Rheumatology, Sygehus Vendsyssel i Hjørring, Hjørring, Denmark
| | - H Lindegaard
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - T Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A H Nielsen
- Department of Radiology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - L Larsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - A G Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - H S Thomsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Sundin U, Sundlisater NP, Aga AB, Sexton J, Nordberg LB, Hammer HB, van der Heijde D, Kvien TK, Haavardsholm EA, Lillegraven S. Value of MRI and ultrasound for prediction of therapeutic response and erosive progression in patients with early rheumatoid arthritis managed by an aggressive treat-to-target strategy. RMD Open 2021; 7:rmdopen-2020-001525. [PMID: 33547228 PMCID: PMC7871342 DOI: 10.1136/rmdopen-2020-001525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate if inflammation detected by MRI or ultrasound at rheumatoid arthritis (RA) onset is predictive of erosive progression or poor response to methotrexate monotherapy, and to investigate if subclinical inflammation in remission is predictive of future treatment escalation or erosive progression. METHODS In a 2-year study, 218 patients with disease-modifying antirheumatic drug-naïve early RA were treated by a tight-control treat-to-target strategy corresponding to current recommendations. MRI and ultrasound were performed at regular intervals. Baseline imaging-based inflammation measures were analysed as predictors for early methotrexate failure and erosive progression using univariate and multivariate regression adjusted for clinical, laboratory and radiographic measures. In patients in remission after 1 year, imaging measures were analysed as predictors of treatment escalation and erosive progression during the second year. The added value of imaging in prediction models was assessed using receiver operating characteristic analyses. RESULTS Baseline MRI inflammation was associated with MRI erosive progression and ultrasound with radiographic erosive progression. No imaging inflammation measure was associated with early methotrexate failure. Imaging inflammation was present in a majority of patients in clinical remission. Tenosynovitis was associated with treatment escalation, and synovitis and tenosynovitis with MRI/radiographic erosive progression during the second year. Imaging information did not improve prediction models for any of the outcomes. CONCLUSIONS Imaging-detected inflammation, both at diagnosis and in remission, is associated with elements of future disease development. However, the lack of a significant effect on prediction models indicates limited value of systematic MRI and ultrasound in management of early RA.
Collapse
Affiliation(s)
- Ulf Sundin
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Paulshus Sundlisater
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lena Bugge Nordberg
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Desirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Department of Rheumatology, Leiden University Medical Center, Leiden, South Holland, The Netherlands
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | |
Collapse
|
19
|
Scott DL, Ibrahim F, Hill H, Tom B, Prothero L, Baggott RR, Bosworth A, Galloway JB, Georgopoulou S, Martin N, Neatrour I, Nikiphorou E, Sturt J, Wailoo A, Williams FMK, Williams R, Lempp H. Intensive therapy for moderate established rheumatoid arthritis: the TITRATE research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Rheumatoid arthritis is a major inflammatory disorder and causes substantial disability. Treatment goals span minimising disease activity, achieving remission and decreasing disability. In active rheumatoid arthritis, intensive management achieves these goals. As many patients with established rheumatoid arthritis have moderate disease activity, the TITRATE (Treatment Intensities and Targets in Rheumatoid Arthritis ThErapy) programme assessed the benefits of intensive management.
Objectives
To (1) define how to deliver intensive therapy in moderate established rheumatoid arthritis; (2) establish its clinical effectiveness and cost-effectiveness in a trial; and (3) evaluate evidence supporting intensive management in observational studies and completed trials.
Design
Observational studies, secondary analyses of completed trials and systematic reviews assessed existing evidence about intensive management. Qualitative research, patient workshops and systematic reviews defined how to deliver it. The trial assessed its clinical effectiveness and cost-effectiveness in moderate established rheumatoid arthritis.
Setting
Observational studies (in three London centres) involved 3167 patients. These were supplemented by secondary analyses of three previously completed trials (in centres across all English regions), involving 668 patients. Qualitative studies assessed expectations (nine patients in four London centres) and experiences of intensive management (15 patients in 10 centres across England). The main clinical trial enrolled 335 patients with diverse socioeconomic deprivation and ethnicity (in 39 centres across all English regions).
Participants
Patients with established moderately active rheumatoid arthritis receiving conventional disease-modifying drugs.
Interventions
Intensive management used combinations of conventional disease-modifying drugs, biologics (particularly tumour necrosis factor inhibitors) and depot steroid injections; nurses saw patients monthly, adjusted treatment and provided supportive person-centred psychoeducation. Control patients received standard care.
Main outcome measures
Disease Activity Score for 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR)-categorised patients (active to remission). Remission (DAS28-ESR < 2.60) was the treatment target. Other outcomes included fatigue (measured on a 100-mm visual analogue scale), disability (as measured on the Health Assessment Questionnaire), harms and resource use for economic assessments.
Results
Evaluation of existing evidence for intensive rheumatoid arthritis management showed the following. First, in observational studies, DAS28-ESR scores decreased over 10–20 years, whereas remissions and treatment intensities increased. Second, in systematic reviews of published trials, all intensive management strategies increased remissions. Finally, patients with high disability scores had fewer remissions. Qualitative studies of rheumatoid arthritis patients, workshops and systematic reviews helped develop an intensive management pathway. A 2-day training session for rheumatology practitioners explained its use, including motivational interviewing techniques and patient handbooks. The trial screened 459 patients and randomised 335 patients (168 patients received intensive management and 167 patients received standard care). A total of 303 patients provided 12-month outcome data. Intention-to-treat analysis showed intensive management increased DAS28-ESR 12-month remissions, compared with standard care (32% vs. 18%, odds ratio 2.17, 95% confidence interval 1.28 to 3.68; p = 0.004), and reduced fatigue [mean difference –18, 95% confidence interval –24 to –11 (scale 0–100); p < 0.001]. Disability (as measured on the Health Assessment Questionnaire) decreased when intensive management patients achieved remission (difference –0.40, 95% confidence interval –0.57 to –0.22) and these differences were considered clinically relevant. However, in all intensive management patients reductions in the Health Assessment Questionnaire scores were less marked (difference –0.1, 95% confidence interval –0.2 to 0.0). The numbers of serious adverse events (intensive management n = 15 vs. standard care n = 11) and other adverse events (intensive management n = 114 vs. standard care n = 151) were similar. Economic analysis showed that the base-case incremental cost-effectiveness ratio was £43,972 from NHS and Personal Social Services cost perspectives. The probability of meeting a willingness-to-pay threshold of £30,000 was 17%. The incremental cost-effectiveness ratio decreased to £29,363 after including patients’ personal costs and lost working time, corresponding to a 50% probability that intensive management is cost-effective at English willingness-to-pay thresholds. Analysing trial baseline predictors showed that remission predictors comprised baseline DAS28-ESR, disability scores and body mass index. A 6-month extension study (involving 95 intensive management patients) showed fewer remissions by 18 months, although more sustained remissions were more likley to persist. Qualitative research in trial completers showed that intensive management was acceptable and treatment support from specialist nurses was beneficial.
Limitations
The main limitations comprised (1) using single time point remissions rather than sustained responses, (2) uncertainty about benefits of different aspects of intensive management and differences in its delivery across centres, (3) doubts about optimal treatment of patients unresponsive to intensive management and (4) the lack of formal international definitions of ‘intensive management’.
Conclusion
The benefits of intensive management need to be set against its additional costs. These were relatively high. Not all patients benefited. Patients with high pretreatment physical disability or who were substantially overweight usually did not achieve remission.
Future work
Further research should (1) identify the most effective components of the intervention, (2) consider its most cost-effective delivery and (3) identify alternative strategies for patients not responding to intensive management.
Trial registration
Current Controlled Trials ISRCTN70160382.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- David L Scott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Fowzia Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Harry Hill
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Louise Prothero
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Rhiannon R Baggott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | | | - James B Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Sofia Georgopoulou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Naomi Martin
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Isabel Neatrour
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Jackie Sturt
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Allan Wailoo
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Frances MK Williams
- Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Ruth Williams
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| |
Collapse
|
20
|
Similar lipid level changes in early rheumatoid arthritis patients following 1-year treat-to-target strategy with adalimumab plus methotrexate versus placebo plus methotrexate: secondary analyses from the randomised controlled OPERA trial. Rheumatol Int 2021; 41:543-549. [PMID: 33386898 DOI: 10.1007/s00296-020-04756-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
To compare changes in low-density lipoprotein cholesterol and other lipids in patients with rheumatoid arthritis (RA) randomised to a 1-year treat-to-target strategy with either adalimumab plus methotrexate or placebo plus methotrexate. Prespecified secondary analyses from the OPERA trial, where 180 early and treatment-naïve RA patients received methotrexate 20 mg once weekly in combination with either placebo or subcutaneous adalimumab 40 mg every other week. Serum lipid levels were measured at baseline and after 1 year. Changes in lipid levels were analysed using mixed linear models based on the intention-to-treat (ITT) population. Overall, 174 patients were included in the ITT population (adalimumab plus methotrexate n = 86; placebo plus methotrexate n = 88). Differences between changes in lipid levels were low-density lipoprotein cholesterol 0.18 mmol/l [95% CI - 0.05 to 0.42], total cholesterol 0.27 mmol/l [- 0.002 to 0.54], high-density lipoprotein cholesterol 0.05 mmol/l [- 0.06 to 0.15], triglycerides 0.11 mmol/l [- 0.08 to 0.29], very-low-density lipoprotein cholesterol 0.03 mmol/l [- 0.05 to 0.12], and non-high-density lipoprotein cholesterol 0.22 mmol/l [- 0.02 to 0.46]. In early RA patients treated to tight control of inflammation over a period of 1 year with either adalimumab plus methotrexate or placebo plus methotrexate, changes in lipid levels were similar. Trial registration number: NCT00660647.
Collapse
|
21
|
Hetland ML, Haavardsholm EA, Rudin A, Nordström D, Nurmohamed M, Gudbjornsson B, Lampa J, Hørslev-Petersen K, Uhlig T, Grondal G, Østergaard M, Heiberg MS, Twisk J, Lend K, Krabbe S, Hyldstrup LH, Lindqvist J, Hultgård Ekwall AK, Grøn KL, Kapetanovic M, Faustini F, Tuompo R, Lorenzen T, Cagnotto G, Baecklund E, Hendricks O, Vedder D, Sokka-Isler T, Husmark T, Ljoså MKA, Brodin E, Ellingsen T, Söderbergh A, Rizk M, Olsson ÅR, Larsson P, Uhrenholt L, Just SA, Stevens DJ, Laurberg TB, Bakland G, Olsen IC, van Vollenhoven R. Active conventional treatment and three different biological treatments in early rheumatoid arthritis: phase IV investigator initiated, randomised, observer blinded clinical trial. BMJ 2020; 371:m4328. [PMID: 33268527 PMCID: PMC7708829 DOI: 10.1136/bmj.m4328] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate and compare benefits and harms of three biological treatments with different modes of action versus active conventional treatment in patients with early rheumatoid arthritis. DESIGN Investigator initiated, randomised, open label, blinded assessor, multiarm, phase IV study. SETTING Twenty nine rheumatology departments in Sweden, Denmark, Norway, Finland, the Netherlands, and Iceland between 2012 and 2018. PARTICIPANTS Patients aged 18 years and older with treatment naive rheumatoid arthritis, symptom duration less than 24 months, moderate to severe disease activity, and rheumatoid factor or anti-citrullinated protein antibody positivity, or increased C reactive protein. INTERVENTIONS Randomised 1:1:1:1, stratified by country, sex, and anti-citrullinated protein antibody status. All participants started methotrexate combined with (a) active conventional treatment (either prednisolone tapered to 5 mg/day, or sulfasalazine combined with hydroxychloroquine and intra-articular corticosteroids), (b) certolizumab pegol, (c) abatacept, or (d) tocilizumab. MAIN OUTCOME MEASURES The primary outcome was adjusted clinical disease activity index remission (CDAI≤2.8) at 24 weeks with active conventional treatment as the reference. Key secondary outcomes and analyses included CDAI remission at 12 weeks and over time, other remission criteria, a non-inferiority analysis, and harms. RESULTS 812 patients underwent randomisation. The mean age was 54.3 years (standard deviation 14.7) and 68.8% were women. Baseline disease activity score of 28 joints was 5.0 (standard deviation 1.1). Adjusted 24 week CDAI remission rates were 42.7% (95% confidence interval 36.1% to 49.3%) for active conventional treatment, 46.5% (39.9% to 53.1%) for certolizumab pegol, 52.0% (45.5% to 58.6%) for abatacept, and 42.1% (35.3% to 48.8%) for tocilizumab. Corresponding absolute differences were 3.9% (95% confidence interval -5.5% to 13.2%) for certolizumab pegol, 9.4% (0.1% to 18.7%) for abatacept, and -0.6% (-10.1% to 8.9%) for tocilizumab. Key secondary outcomes showed no major differences among the four treatments. Differences in CDAI remission rates for active conventional treatment versus certolizumab pegol and tocilizumab, but not abatacept, remained within the prespecified non-inferiority margin of 15% (per protocol population). The total number of serious adverse events was 13 (percentage of patients who experienced at least one event 5.6%) for active conventional treatment, 20 (8.4%) for certolizumab pegol, 10 (4.9%) for abatacept, and 10 (4.9%) for tocilizumab. Eleven patients treated with abatacept stopped treatment early compared with 20-23 patients in the other arms. CONCLUSIONS All four treatments achieved high remission rates. Higher CDAI remission rate was observed for abatacept versus active conventional treatment, but not for certolizumab pegol or tocilizumab versus active conventional treatment. Other remission rates were similar across treatments. Non-inferiority analysis indicated that active conventional treatment was non-inferior to certolizumab pegol and tocilizumab, but not to abatacept. The results highlight the efficacy and safety of active conventional treatment based on methotrexate combined with corticosteroids, with nominally better results for abatacept, in treatment naive early rheumatoid arthritis. TRIAL REGISTRATION EudraCT2011-004720-35, NCT01491815.
Collapse
Affiliation(s)
- Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE) and DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anna Rudin
- Rheumatology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Gothenburg, Sweden
| | - Dan Nordström
- Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Michael Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Reade, Netherlands
- Department of Rheumatology and Amsterdam Rheumatology Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bjorn Gudbjornsson
- Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jon Lampa
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Gerdur Grondal
- Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE) and DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marte S Heiberg
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Kristina Lend
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research (COPECARE) and DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise Hejl Hyldstrup
- Copenhagen Center for Arthritis Research (COPECARE) and DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joakim Lindqvist
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Hultgård Ekwall
- Rheumatology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy of University of Gothenburg, Gothenburg, Sweden
| | - Kathrine Lederballe Grøn
- Copenhagen Center for Arthritis Research (COPECARE) and DANBIO, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Meliha Kapetanovic
- Section of Rheumatology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund and Malmö, Sweden
| | - Francesca Faustini
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Riitta Tuompo
- Division of Rheumatology, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Tove Lorenzen
- Department of Rheumatology, Silkeborg University Clinic, Silkeborg, Denmark
| | - Giovanni Cagnotto
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Daisy Vedder
- Amsterdam Rheumatology and Immunology Center, Reade, Netherlands
| | - Tuulikki Sokka-Isler
- Department of Medicine and University of Eastern Finland, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Tomas Husmark
- Department of Rheumatology, Falu Hospital, Falun, Sweden
| | | | - Eli Brodin
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital, Southern University of Denmark, Denmark
| | - Annika Söderbergh
- Department of Rheumatology, Örebro University Hospital, Örebro, Sweden
| | - Milad Rizk
- Rheumatology Clinic, Västmanlands Hospital Västerås, Sweden
| | | | - Per Larsson
- Academic Specialist Center, Stockholm, Sweden
| | - Line Uhrenholt
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Andreas Just
- Section of Rheumatology, Department of Medicine, Svendborg Hospital OUH, Denmark
| | - David John Stevens
- Department of Rheumatology, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway
| | | | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
| | - Inge C Olsen
- Department of Research Support for Clinical Trials, Oslo University Hospital, Norway
| | - Ronald van Vollenhoven
- Department of Rheumatology and Amsterdam Rheumatology Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
22
|
Solomon A, Stanwix AE, Castañeda S, Llorca J, Gonzalez-Juanatey C, Hodkinson B, Romela B, Ally MMTM, Maharaj AB, Van Duuren EM, Ziki JJ, Seboka M, Mohapi M, Jansen Van Rensburg BJ, Tarr GS, Makan K, Balton C, Gogakis A, González-Gay MA, Dessein PH. Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country. BMC Rheumatol 2020; 4:42. [PMID: 32550295 PMCID: PMC7296622 DOI: 10.1186/s41927-020-00139-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
Collapse
Affiliation(s)
- Ahmed Solomon
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Anne E Stanwix
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Santos Castañeda
- Rheumatology Department, Hospital de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Javier Llorca
- Universidad de Cantabria - IDIVAL, CIBER Epidemiologia y Salud Pública (CIBERESP), Santander, Spain
| | | | - Bridget Hodkinson
- Rheumatology Department, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Benitha Romela
- Rheumatology Unit, Wilgeheuwel Hospital, Johannesburg, South Africa
| | - Mahmood M T M Ally
- Rheumatology Department, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Ajesh B Maharaj
- Rheumatology Unit, Westville Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Elsa M Van Duuren
- Rheumatology Division, Department of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Joyce J Ziki
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Mpoti Seboka
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Makgotso Mohapi
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | | | - Gareth S Tarr
- Rheumatology Department, Tygerberg Hospital, Faculty of Health Sciences, Physiological Sciences Department, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | - Kavita Makan
- Rheumatology Department, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Charlene Balton
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Aphrodite Gogakis
- Radiology Unit, Rivonia Road Medical Centre, Morningside, Johannesburg, South Africa
| | - Miguel A González-Gay
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Spain; University of Cantabria, Santander, Spain
| | - Patrick H Dessein
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa.,School of Physiology and School of Clinical Medicine, Faculty Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Free University and University Hospital, Brussels, Belgium
| |
Collapse
|
23
|
|
24
|
Abstract
Treat-to-target has been established as a guiding principle for the treatment of rheumatoid arthritis (RA) and encompasses several distinct elements: choosing a target and a method for measuring it; assessing the target at a pre-specified time point; a commitment to change the therapy if the target is not achieved; and shared decision-making. A treat-to-target approach yields superior outcomes to standard care in RA, and the ACR, EULAR and other professional organizations have endorsed treat-to-target as a fundamental therapeutic strategy for RA. Nevertheless, data on the degree to which treat-to-target is employed in the clinic are scarce; it seems that although some elements of treat-to-target are widely used, full implementation remains uncommon. Outstanding knowledge gaps to be addressed include how to select the right target for each patient, how often to assess whether the target has been achieved and the selection of each subsequent therapy in an evidence-based manner.
Collapse
|
25
|
Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. PLoS One 2020; 15:e0226754. [PMID: 31895926 PMCID: PMC6939943 DOI: 10.1371/journal.pone.0226754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023] Open
Abstract
Objective Recent guideline updates have suggested de-escalating DMARDs when patients with rheumatoid arthritis achieve remission or low disease activity. We aim to evaluate whether it is cost-effective to de-escalate the biological form of DMARDs (bDMARDs). Methods Using a Markov model, we performed a cost-utility analysis for RA patients on bDMARD treatment. We compared continuing treatment (standard care) to a tapering approach (i.e., an immediate 50% dose reduction), withdrawal (i.e., an immediate 100% dose reduction) and tapering followed by withdrawal of bDMARDs. The parametrization is based on a comprehensive literature review. Results were computed for 30 years with a cycle length of three months. We applied the payer’s perspective for Germany and conducted deterministic and probabilistic sensitivity analyses. Results Tapering or withdrawing bDMARD treatment resulted in ICERs of €526,254 (incr. costs -78,845, incr. QALYs -0.1498) or €216,879 (incr. costs -€121,691, incr. QALYs -0.5611) compared to standard care. Tapering followed by withdrawal resulted in a loss of 0.4354 QALYs and savings of €107,969 per patient, with an ICER of €247,987. Deterministic sensitivity analysis revealed that our results remained largely unaffected by parameter changes. Probabilistic sensitivity analysis suggests that tapering, withdrawal and tapering followed by withdrawal were dominant in 39.8%, 28.2% and 29.0% of 10,000 iterations. Conclusion Our findings suggest that de-escalating bDMARDs in patients with RA may result in high cost savings but also a decrease in quality of life compared to standard care. If decision makers choose to implement de-escalation in daily practice, our results suggest the tapering approach.
Collapse
|
26
|
Greisen SR, Kragstrup TW, Thomsen JS, Hansen AS, Krishnamurthy A, Hørslev-Petersen K, Hetland ML, Stengaard-Pedersen K, Østergaard M, Ørnbjerg LM, Junker P, Sharpe AH, Freeman GJ, Annamalai L, Hvid M, Moestrup SK, Hauge EM, Catrina AI, Deleuran B. Programmed death ligand 2 - A link between inflammation and bone loss in rheumatoid arthritis. J Transl Autoimmun 2019; 3:100028. [PMID: 32743513 PMCID: PMC7388353 DOI: 10.1016/j.jtauto.2019.100028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/02/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Active rheumatoid arthritis (RA) is accompanied by increased appendicular and axial bone loss, closely associated to the degree of inflammation. The programmed death-1 (PD-1) pathway is important for maintaining peripheral tolerance, and its ligand PD-L2 has recently been associated with bone morphogenetic protein activity. Here, we report that PD-L2 plays a central role in RA osteoimmunology. Methods Femoral bone mineral density (BMD) and trabecular bone microstructure were evaluated by micro-CT in wild type (WT) and PD-L2−/− mice. Osteoclasts were generated from RA synovial fluid mononuclear cells and peripheral blood monocytes. The effects of recombinant PD-L2, was evaluated by tartrate-resistant acid phosphatase (TRAP) activity and the development of bone erosions in the presence of anti-citrullinated protein antibodies (ACPA). Plasma soluble (s)PD-L2 levels were measured in patients with early (e)RA (n = 103) treated with methotrexate alone or in combination with the TNF inhibitor Adalimumab. Results PD-L2−/− mice had a decreased BMD and deteriorated trabecular bone microstructure that was not related to the RANKL/OPG pathway. PD-L2 decreased TRAP activity in osteoclasts and decreased ACPA-induced erosions. In the RA synovial membrane PD-L2 was highly expressed especially in the lining layer and plasma sPD-L2 levels were increased in eRA patients and decreased with treatment. One-year sPD-L2 correlated inversely with erosive progression two years after treatment initiation with methotrexate and placebo. Conclusion PD-L2 regulates bone homeostasis in RA. Our findings provide new insight into the relationship between the immune system and bone homeostasis, and suggest a potential therapeutic target for limiting inflammatory bone loss in RA. PD-L2 is closely related to bone homeostasis in a mouse model. PD-L2 inhibits osteoclastogenesis and osteoclast activation in vitro. PD-L2 is highly expressed by cells in the synovial membrane of rheumatoid arthritis. PD-L2 is associated with less radiographic progression in patients with early rheumatoid arthritis.
Collapse
Affiliation(s)
- Stinne R Greisen
- Dept. of Biomedicine, Aarhus University, Denmark.,Dept. of Rheumatology, Aarhus University Hospital, Denmark
| | - Tue W Kragstrup
- Dept. of Biomedicine, Aarhus University, Denmark.,Dept. of Rheumatology, Aarhus University Hospital, Denmark
| | | | | | - Akilan Krishnamurthy
- Rheumatology Division, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Sweden
| | - Kim Hørslev-Petersen
- King Christian 10th Hospital for the Rheumatic Diseases, And University of Southern Denmark, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Peter Junker
- Dept. of Rheumatology, Odense University Hospital, Denmark
| | - Arlene H Sharpe
- Dept. of Microbiology and Immunobiology, Dept. of Pathology, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, USA
| | | | - Malene Hvid
- Dept. of Biomedicine, Aarhus University, Denmark.,Dept. of Clinical Medicine, Aarhus University, Denmark
| | | | - Ellen-Margrethe Hauge
- Dept. of Rheumatology, Aarhus University Hospital, Denmark.,Dept. of Clinical Medicine, Aarhus University, Denmark
| | - Anca Irinel Catrina
- Rheumatology Division, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Sweden
| | - Bent Deleuran
- Dept. of Biomedicine, Aarhus University, Denmark.,Dept. of Rheumatology, Aarhus University Hospital, Denmark
| |
Collapse
|
27
|
Donahue KE, Schulman ER, Gartlehner G, Jonas BL, Coker-Schwimmer E, Patel SV, Weber RP, Bann CM, Viswanathan M. Comparative Effectiveness of Combining MTX with Biologic Drug Therapy Versus Either MTX or Biologics Alone for Early Rheumatoid Arthritis in Adults: a Systematic Review and Network Meta-analysis. J Gen Intern Med 2019; 34:2232-2245. [PMID: 31388915 PMCID: PMC6816735 DOI: 10.1007/s11606-019-05230-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/13/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Comparative effectiveness of early rheumatoid arthritis (RA) treatments remains uncertain. PURPOSE Compare benefits and harms of biologic drug therapies for adults with early RA within 1 year of diagnosis. DATA SOURCES English language articles from the 2012 review to October 2017 identified through MEDLINE, Cochrane Library and International Pharmaceutical Abstracts, gray literature, expert recommendations, reference lists of published literature, and supplemental evidence data requests. STUDY SELECTION Two persons independently selected studies based on predefined inclusion criteria. DATA EXTRACTION One reviewer extracted data; a second reviewer checked accuracy. Two independent reviewers assigned risk of bias ratings. DATA SYNTHESIS We identified 22 eligible studies with 9934 participants. Combination therapy with tumor necrosis factor (TNF) or non-TNF biologics plus methotrexate (MTX) improved disease control, remission, and functional capacity compared with monotherapy of either MTX or a biologic. Network meta-analyses found higher ACR50 response (50% improvement) for combination therapy of biologic plus MTX than for MTX monotherapy (relative risk range 1.20 [95% confidence interval (CI), 1.04 to 1.38] to 1.57 [95% CI, 1.30 to 1.88]). No significant differences emerged between treatment discontinuation rates because of adverse events or serious adverse events. Subgroup data (disease activity, prior therapy, demographics, serious conditions) were limited. LIMITATIONS Trials enrolled almost exclusively selected populations with high disease activity. Network meta-analyses were derived from indirect comparisons relative to MTX due to the dearth of head-to-head studies comparing interventions. No eligible data on biosimilars were found. CONCLUSIONS Qualitative and network meta-analyses suggest that the combination of MTX with TNF or non-TNF biologics reduces disease activity and improves remission when compared with MTX monotherapy. Overall adverse event and discontinuation rates were similar between treatment groups. REGISTRATION PROSPERO (available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017079260 ).
Collapse
Affiliation(s)
- Katrina E Donahue
- University of North Carolina Department of Family Medicine, Chapel Hill, NC, USA. .,Cecil G Sheps Center for Health Services Research, Chapel Hill, NC, USA.
| | | | - Gerald Gartlehner
- RTI International, Research Triangle Park, NC, USA.,Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria
| | - Beth L Jonas
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | | |
Collapse
|
28
|
Chatzidionysiou K, Sfikakis PP. Low rates of remission with methotrexate monotherapy in rheumatoid arthritis: review of randomised controlled trials could point towards a paradigm shift. RMD Open 2019; 5:e000993. [PMID: 31413870 PMCID: PMC6667970 DOI: 10.1136/rmdopen-2019-000993] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 11/29/2022] Open
Abstract
Treatment of rheumatoid arthritis (RA) has improved substantially during the last decades, mainly due to the development and introduction in everyday practice of new, highly efficacious, disease-modifying antirheumatic drugs (DMARDs), more optimal usage of them, earlier diagnosis and tighter control of disease activity targeting at remission. Methotrexate is still today the anchor drug and the first-line treatment after diagnosis. However, numerous studies comparing methotrexate and biologic DMARDs, as well as new targeted synthetic DMARDs, both in early as in more established disease, have shown consistently better efficacy of the latter compared with methotrexate, with methotrexate yielding remission to maximum half of patients. This could suggest a new paradigm shift with earlier start of a biologic or a targeted synthetic DMARD, with the possibility of subsequent discontinuation in case of achievement of stable remission. Several strategy trials, however, have shown that there might be a clinical and structural benefit of initial, aggressive therapy, possibly even associated with higher chance of remaining in remission, after cessation of the biologic DMARD and continuing with methotrexate alone, but they have failed to show a clear advantage of such an aggressive treatment strategy. This might become a valuable option for the future treatment algorithm of RA, especially for a subgroup of patients with RA, but further confirmation from future research is needed. The crucial role of glucocorticoid use as part of the combination strategy should be acknowledged, and strategy trials should include this combination as an active comparator.
Collapse
Affiliation(s)
- Katerina Chatzidionysiou
- First Department of Propaedeutic and Internal Medicine and Joined Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine and Joined Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
| |
Collapse
|
29
|
Verhoeven MMA, Welsing PMJ, Bijlsma JWJ, van Laar JM, Lafeber FPJG, Tekstra J, Jacobs JWG. Effectiveness of Remission Induction Strategies for Early Rheumatoid Arthritis: a Systematic Literature Review. Curr Rheumatol Rep 2019; 21:24. [PMID: 31016409 PMCID: PMC6478774 DOI: 10.1007/s11926-019-0821-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To review the effectiveness of remission induction strategies compared to single csDMARD-initiating strategies according to current guidelines in early RA. RECENT FINDINGS Twenty-nine studies, heterogeneous on, e.g., specific treatment strategy and remission outcome used, were identified. Using DAS28-remission over 12 months, 13 (76%) of 17 remission induction strategies showed significantly more patients achieving remission. Pooled relative "risk" was 1.73 [95%CI 1.59-1.88] for bDMARD-based remission induction strategies and 1.20 [95%CI 1.03-1.40] for combination csDMARD-based remission induction strategies compared to single csDMARD-initiating strategies. When additional glucocorticoid "bridging therapy" was used in single csDMARD-initiating strategies, the higher proportion patients achieving remission in remission induction strategies was no longer statistically significant (pooled RR 1.06 [95%CI 0.83-1.35]). For other remission outcomes, results were in line with above. Remission induction strategies are more effective in achieving remission compared to single csDMARD-initiating strategies, possibly more so in bDMARD-based induction strategies. However, compared to single csDMARD-initiating strategies with glucocorticoids, induction strategies may not be more effective.
Collapse
Affiliation(s)
- M M A Verhoeven
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands.
| | - P M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J W J Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J Tekstra
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - J W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, G02.228, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| |
Collapse
|
30
|
Petta I, Peene I, Elewaut D, Vereecke L, De Bosscher K. Risks and benefits of corticosteroids in arthritic diseases in the clinic. Biochem Pharmacol 2019; 165:112-125. [PMID: 30978323 DOI: 10.1016/j.bcp.2019.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/08/2019] [Indexed: 02/06/2023]
Abstract
Glucocorticoids (GCs) constitute a first line treatment for many autoimmune and inflammatory diseases. Due to their potent anti-inflammatory and immunosuppressive actions, GCs are added frequently to disease modifying antirheumatic drugs (DMARDs) in various arthritic diseases, such as rheumatoid arthritis. However, their prolonged administration or administration at high doses is associated with adverse effects that may be (quality of) life-threatening, including osteoporosis, metabolic, gastrointestinal and cardiovascular side effects. In this review, we summarize the clinical and pharmacological effects of GCs in different arthritic diseases, while documenting the current research efforts towards the identification of novel and more efficient GCs with reduced side effects.
Collapse
Affiliation(s)
- Ioanna Petta
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Host-Microbiota Interaction Lab (HMI) and Laboratory for Molecular Immunology and Inflammation, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research (IRC), Ghent University, Technologiepark 71 - Zwijnaarde, 9052 Ghent, Belgium; Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium
| | - Isabelle Peene
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Host-Microbiota Interaction Lab (HMI) and Laboratory for Molecular Immunology and Inflammation, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research (IRC), Ghent University, Technologiepark 71 - Zwijnaarde, 9052 Ghent, Belgium; Department of Rheumatology, AZ SintJan, Ruddershove 10, 8000 Brugge, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Host-Microbiota Interaction Lab (HMI) and Laboratory for Molecular Immunology and Inflammation, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research (IRC), Ghent University, Technologiepark 71 - Zwijnaarde, 9052 Ghent, Belgium; Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium
| | - Lars Vereecke
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Host-Microbiota Interaction Lab (HMI) and Laboratory for Molecular Immunology and Inflammation, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; VIB Center for Inflammation Research (IRC), Ghent University, Technologiepark 71 - Zwijnaarde, 9052 Ghent, Belgium; Ghent Gut Inflammation Group (GGIG), Ghent University, Ghent, Belgium
| | - Karolien De Bosscher
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium; Translational Nuclear Receptor Research, VIB Center for Medical Biotechnology, Albert Baertsoenkaai 3, 9000, Ghent, Belgium.
| |
Collapse
|
31
|
Long-Term Efficacy of Tumor Necrosis Factor Inhibitors for the Treatment of Methotrexate-Naïve Rheumatoid Arthritis: Systematic Literature Review and Meta-Analysis. Adv Ther 2019; 36:721-745. [PMID: 30637590 DOI: 10.1007/s12325-018-0869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Synthesis of evidence on the long-term use of first-line biologic therapy in patients with early rheumatoid arthritis (RA) is required. We compared the efficacy of up to 5 years' treatment with first-line tumor necrosis factor inhibitors (TNFis) versus other treatment strategies in this population. METHODS Previous systematic reviews, PubMed and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) involving treatment of methotrexate-naïve RA patients with first-line TNFis. Literature was synthesized qualitatively, and a meta-analysis conducted to evaluate American College of Rheumatology (ACR) responses, clinical remission defined by any standard measure, and Health Assessment Questionnaire Disability Index (HAQ) at Years 2 and/or 5. RESULTS Ten RCTs involving 4306 patients [first-line TNFi, n = 2234; other treatment strategies (control), n = 2072] were included in the meta-analysis. Three studies were double-blind for the first 2 years, while seven were partly/completely open label during this period. Five studies reported data at Year 5; all were open label at this time point. At Year 2, ACR50 response, ACR70 response and remission rates were significantly improved with first-line TNFi versus control in double-blind RCTs [log-odds ratio (OR) 0.32 [95% confidence interval (CI) 0.02, 0.62; p = 0.035], log-OR 0.48 (95% CI 0.20, 0.77; p = 0.001), and log-OR 0.44 (95% CI 0.13, 0.74; p = 0.005), respectively], but not in open-label studies. No significant between-group differences were observed in mean HAQ at Year 2 in double-blind or open-label RCTs or in ACR response or remission outcomes at Year 5. CONCLUSION In double-blind studies, 2-year efficacy outcomes were significantly improved with first-line TNFi versus other treatment strategies in patients with MTX-naïve RA. No significant differences in these outcomes were observed when data from open-label RCTs were considered on their own. Further data on the efficacy of TNFi therapy over ≥ 2 years in patients with methotrexate-naïve RA are required. Plain language summary available for this article.
Collapse
|
32
|
Sundin U, Østergaard M, Glinatsi D, Aga AB, Hørslev-Petersen K, Hetland ML, Stengard-Pedersen K, Junker P, Ejbjerg BJ, Bird P, Conaghan PG, Lillegraven S, Haavardsholm EA. Validity and Responsiveness of Combined Inflammation and Combined Joint Damage Scores Based on the OMERACT Rheumatoid Arthritis MRI Scoring System (RAMRIS). J Rheumatol 2019; 46:1222-1227. [PMID: 30770509 DOI: 10.3899/jrheum.181064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The RAMRIS [Outcome Measures in Rheumatology rheumatoid arthritis (RA) magnetic resonance imaging (MRI) Scoring system] is used in clinical RA trials. We have investigated methods to combine the RAMRIS features into valid and responsive scores for inflammation and joint damage. METHODS We used data from 3 large randomized early RA trials to assess 5 methods to develop a combined score for inflammation based on RAMRIS bone marrow edema, synovitis, and tenosynovitis scores, and a combined joint damage score based on erosions and joint space narrowing. Methods included unweighted summation, normalized summation, and 3 different variants of weighted summation of the RAMRIS features. We used a derivation cohort to calculate summation weights to maximize the responsiveness of the combined score. Construct validity of the combined scores was examined by assessing correlations to imaging, clinical, and biochemical measures. Responsiveness was tested by calculating the standardized response mean (SRM) and the relative efficiency of each score in a validation cohort. RESULTS Patient characteristics, as well as baseline and followup RAMRIS scores, were comparable between cohorts. All combined scores were significantly correlated to other imaging, clinical, and biochemical measures. Inflammation scores combined by normalized and weighted summation had significantly higher responsiveness in comparison to unweighted summation, with SRM (95% CI) for unweighted summation 0.62 (0.51-0.73), normalized summation 0.73 (0.63-0.83), and weighted summation 0.74 (0.64-0.84). For the damage score, there was a trend toward higher responsiveness for weighted summation. CONCLUSION Combined MRI scores calculated by normalized or weighted summation of individual MRI pathologies were valid and responsive.
Collapse
Affiliation(s)
- Ulf Sundin
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK. .,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo.
| | - Mikkel Østergaard
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Daniel Glinatsi
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Anna-Birgitte Aga
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Kim Hørslev-Petersen
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Merete L Hetland
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Kristian Stengard-Pedersen
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Peter Junker
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Bo J Ejbjerg
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Paul Bird
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Philip G Conaghan
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Siri Lillegraven
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| | - Espen A Haavardsholm
- From the Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, University of Oslo, Oslo, Norway; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen; King Christian 10th Hospital for Rheumatic Diseases; University of Southern Denmark, Institute of Regional Health Research, Graasten; Institute of Clinical Medicine, Aarhus University Hospital, Århus; Odense University Hospital; Institute of Clinical Research, University of Southern Denmark, Odense; Zealand University Hospital, Køge, Denmark; University of New South Wales, Sydney, Australia; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK.,U. Sundin, MD, Research Fellow, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; D. Glinatsi, MD, PhD, Postdoctoral Researcher, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet; A.B. Aga, MD, PhD, Senior Consultant and Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital Oslo; K. Hørslev-Petersen, MD, DMSc, Professor, Senior Consultant, King Christian 10th Hospital for Rheumatic Diseases, and the Institute of Regional Health Research, University of Southern Denmark; M.L. Hetland, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen; K. Stengaard-Pedersen, MD, DMSc, Professor Emeritus, Institute of Clinical Medicine, Aarhus University Hospital; P. Junker, MD, DMSc, Professor, Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; B.J. Ejbjerg, MD, PhD, Chief Consultant, Zealand University Hospital; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of New South Wales; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; S. Lillegraven, MD, MPH, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, University of Oslo
| |
Collapse
|
33
|
Linauskas A, Overvad K, Johansen MB, Stengaard-Pedersen K, de Thurah A. Positive predictive value of first-time rheumatoid arthritis diagnoses and their serological subtypes in the Danish National Patient Registry. Clin Epidemiol 2018; 10:1709-1720. [PMID: 30538575 PMCID: PMC6254991 DOI: 10.2147/clep.s175406] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purposes To assess whether the positive predictive value (PPV) of first-time rheumatoid arthritis (RA) diagnosis registration in the Danish National Patient Registry increases when data are linked to the RA treatment codes and to assess the PPV of first-time RA diagnoses according to RA serological subtypes. Methods Participants from the Danish Diet, Cancer, and Health cohort with at least one RA diagnosis, registered at one of the Central Denmark Region hospitals in the Danish National Patient Registry during the period 1977–2016, were identified. Register-based RA diagnoses were verified by scrutinizing medical records against RA classification criteria or clinical case RA. PPVs for overall RA, seropositive RA, and other RA were calculated for two models: first-time RA diagnosis registration ever in the Danish National Patient Registry and first-time RA diagnosis registration ever where subsequently a prescription had been redeemed for a synthetic disease-modifying antirheumatic drug. Results Overall, 205 of 311 first-time register-based RA diagnoses were verified (PPV: 61.9%; 95% CI: 56.9–67.0). Regarding RA serological subtypes, 93 of 150 register-based seropositive RA (PPV: 62.0; 95% CI: 53.9–69.5) and 36 of 144 other RA (PPV: 25.0; 95% CI: 18.5–32.8) were confirmed. When register-based RA diagnosis codes were linked to RA treatment codes, the PPVs increased substantially: the PPV for overall RA was 87.7% (95% CI: 82.5–91.5), the PPV for seropositive RA was 80.2% (95% CI: 71.6–86.7), and the PPV for other RA was 41.1% (95% CI: 30.2–52.9). Conclusion The first-time RA diagnoses in the Danish National Patient Registry should be used with caution in epidemiology research. However, linking registry-based RA diagnoses to the subsequent RA treatment codes increases the probability of identifying true RA diagnoses, especially overall RA and seropositive RA.
Collapse
Affiliation(s)
- Asta Linauskas
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Rheumatology, North Denmark Regional Hospital, Hjoerring, Denmark,
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Kristian Stengaard-Pedersen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
34
|
Hughes CD, Scott DL, Ibrahim F. Intensive therapy and remissions in rheumatoid arthritis: a systematic review. BMC Musculoskelet Disord 2018; 19:389. [PMID: 30376836 PMCID: PMC6208111 DOI: 10.1186/s12891-018-2302-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 10/11/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We systematically reviewed the effectiveness of intensive treatment strategies in achieving remission in patients with both early and established Rheumatoid Arthritis (RA). METHODS A systematic literature review and meta-analysis evaluated trials and comparative studies reporting remission in RA patients treated intensively with disease modifying anti-rheumatic drugs (DMARDs), biologics and Janus Kinase (JAK) inhibitors. Analysis used RevMan 5.3 to report relative risks (RR) in random effects models with 95% confidence intervals (CI). RESULTS We identified 928 publications: 53 studies were included (48 superiority studies; 6 head-to-head trials). In the superiority studies 3013/11259 patients achieved remission with intensive treatment compared with 1211/8493 of controls. Analysis of the 53 comparisons showed a significant benefit for intensive treatment (RR 2.23; 95% CI 1.90, 2.61). Intensive treatment increased remissions in both early RA (23 comparisons; RR 1.56; 1.38, 1.76) and established RA (29 comparisons RR 4.21, 2.92, 6.07). All intensive strategies (combination DMARDs, biologics, JAK inhibitors) increased remissions. In the 6 head-to-head trials 317/787 patients achieved remission with biologics compared with 229/671 of patients receiving combination DMARD therapies and there was no difference between treatment strategies (RR 1.06; 0.93. 1.21). There were differences in the frequency of remissions between early and established RA. In early RA the frequency of remissions with active treatment was 49% compared with 34% in controls. In established RA the frequency of remissions with active treatment was 19% compared with 6% in controls. CONCLUSIONS Intensive treatment with combination DMARDs, biologics or JAK inhibitors increases the frequency of remission compared to control non-intensive strategies. The benefits are seen in both early and established RA.
Collapse
Affiliation(s)
- Catherine D Hughes
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK.
| | - David L Scott
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - Fowzia Ibrahim
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| |
Collapse
|
35
|
Wailoo A, Hock ES, Stevenson M, Martyn-St James M, Rawdin A, Simpson E, Wong R, Dracup N, Scott DL, Young A. The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis. Health Technol Assess 2018; 21:1-258. [PMID: 29206093 DOI: 10.3310/hta21710] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Treat to target (TTT) is a broad concept for treating patients with rheumatoid arthritis (RA). It involves setting a treatment target, usually remission or low disease activity (LDA). This is often combined with frequent patient assessment and intensive and rapidly adjusted drug treatment, sometimes based on a formal protocol. OBJECTIVE To investigate the clinical effectiveness and cost-effectiveness of TTT compared with routine care. DATA SOURCES Databases including EMBASE and MEDLINE were searched from 2008 to August 2016. REVIEW METHODS A systematic review of clinical effectiveness was conducted. Studies were grouped according to comparisons made: (1) TTT compared with usual care, (2) different targets and (3) different treatment protocols. Trials were subgrouped by early or established disease populations. Study heterogeneity precluded meta-analyses. Narrative synthesis was undertaken for the first two comparisons, but was not feasible for the third. A systematic review of cost-effectiveness was also undertaken. No model was constructed as a result of the heterogeneity among studies identified in the clinical effectiveness review. Instead, conclusions were drawn on the cost-effectiveness of TTT from papers relating to these studies. RESULTS Sixteen clinical effectiveness studies were included. They differed in terms of treatment target, treatment protocol (where one existed) and patient visit frequency. For several outcomes, mixed results or evidence of no difference between TTT and conventional care was found. In early disease, two studies found that TTT resulted in favourable remission rates, although the findings of one study were not statistically significant. In established disease, two studies showed that TTT may be beneficial in terms of LDA at 6 months, although, again, in one case the finding was not statistically significant. The TICORA (TIght COntrol for RA) trial found evidence of lower remission rates for TTT in a mixed population. Two studies reported cost-effectiveness: in one, TTT dominated usual care; in the other, step-up combination treatments were shown to be cost-effective. In 5 of the 16 studies included the clinical effectiveness review, no cost-effectiveness conclusion could be reached, and in one study no conclusion could be drawn in the case of patients denoted low risk. In the remaining 10 studies, and among patients denoted high risk in one study, cost-effectiveness was inferred. In most cases TTT is likely to be cost-effective, except where biological treatment in early disease is used initially. No conclusions could be drawn for established disease. LIMITATIONS TTT refers not to a single concept, but to a range of broad approaches. Evidence reflects this. Studies exhibit substantial heterogeneity, which hinders evidence synthesis. Many included studies are at risk of bias. FUTURE WORK Future studies comparing TTT with usual care must link to existing evidence. A consistent definition of remission in studies is required. There may be value in studies to establish the importance of different elements of TTT (the setting of a target, the intensive use of drug treatments and protocols pertaining to those drugs and the frequent assessment of patients). CONCLUSION In early RA and studies of mixed early and established RA populations, evidence suggests that TTT improves remission rates. In established disease, TTT may lead to improved rates of LDA. It remains unclear which element(s) of TTT (the target, treatment protocols or increased frequency of patient visits) drive these outcomes. Future trials comparing TTT with usual care and/or different TTT targets should use outcomes comparable with existing literature. Remission, defined in a consistent manner, should be the target of choice of future studies. STUDY REGISTRATION This study is registered as PROSPERO CRD42015017336. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Allan Wailoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma S Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Andrew Rawdin
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Naila Dracup
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - David L Scott
- King's College Hospital NHS Foundation Trust, London, UK
| | - Adam Young
- West Hertfordshire Hospitals NHS Trust, Watford, UK
| |
Collapse
|
36
|
Bartels LE, Pedersen AB, Kristensen NR, Jepsen P, Vilstrup H, Stengaard-Pedersen K, Dahlerup JF. Helicobacter pylori infection is not associated with rheumatoid arthritis. Scand J Rheumatol 2018; 48:24-31. [DOI: 10.1080/03009742.2018.1464205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- LE Bartels
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - AB Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - NR Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Jepsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - H Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - JF Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
37
|
Brahe CH, Østergaard M, Johansen JS, Defranoux N, Wang X, Bolce R, Sasso EH, Ørnbjerg LM, Hørslev-Petersen K, Stengaard-Pedersen K, Junker P, Ellingsen T, Ahlquist P, Lindegaard H, Linauskas A, Schlemmer A, Dam MY, Hansen I, Lottenburger T, Ammitzbøll C, Jørgensen A, Krintel SB, Raun J, Hetland ML. Predictive value of a multi-biomarker disease activity score for clinical remission and radiographic progression in patients with early rheumatoid arthritis: a post-hoc study of the OPERA trial. Scand J Rheumatol 2018; 48:9-16. [PMID: 29985080 DOI: 10.1080/03009742.2018.1464206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Measurement of serum biomarkers at disease onset may improve prediction of disease course in patients with early rheumatoid arthritis (RA). We evaluated the multi-biomarker disease activity (MBDA) score and early changes in MBDA score for prediction of 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP) remission and radiographic progression in the double-blinded OPERA trial. METHOD Treatment-naïve RA patients (N = 180) with moderate or high DAS28 were randomized to methotrexate (MTX) + adalimumab (n = 89) or MTX + placebo (n = 91) in combination with glucocorticoid injection into swollen joints. X-rays of hands and feet were evaluated at months 0 and 12 (n = 164) by the total Sharp van der Heijde score (TSS). The smallest detectable change (1.8 TSS units) defined radiographic progression (∆TSS ≥ 2). Clinical remission (DAS28-CRP < 2.6) was assessed at baseline and 6 months. MBDA score was determined at 0 and 3 months and tested in a multivariable logistic regression model for predicting DAS28 remission at 6 months and radiographic progression at 1 year. RESULTS Baseline MBDA score was independently associated with radiographic progression at 1 year [odds ratio (OR) = 1.03/unit, 95% confidence interval (CI) = 1.01-1.06], and changes in MBDA score from baseline to 3 months with clinical remission at 6 months [OR = 0.98/unit, 95% CI 0.96-1.00). In anti-cyclic citrullinated peptide antibody (anti-CCP)-positive patients, 35 of 89 with high MBDA score (> 44) showed radiographic progression (PPV = 39%), compared with 0 of 15 patients (NPV = 100%) with low/moderate MBDA score (≤ 44) (p = 0.003). CONCLUSION Early changes in MBDA score were associated with clinical remission based on DAS28-CRP at 6 months. In anti-CCP-positive patients, a non-high baseline MBDA score (≤ 44) had a clinical value by predicting very low risk of radiographic progression at 12 months.
Collapse
Affiliation(s)
- C H Brahe
- a Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark.,c DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark
| | - M Østergaard
- a Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark.,c DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark
| | - J S Johansen
- d Department of Medicine and Oncology , Copenhagen University Hospital at Herlev , Herlev , Denmark
| | - N Defranoux
- e Crescendo Bioscience Inc ., San Francisco , CA , USA
| | - X Wang
- e Crescendo Bioscience Inc ., San Francisco , CA , USA
| | - R Bolce
- e Crescendo Bioscience Inc ., San Francisco , CA , USA
| | - E H Sasso
- e Crescendo Bioscience Inc ., San Francisco , CA , USA
| | - L M Ørnbjerg
- a Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark.,c DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark
| | - K Hørslev-Petersen
- f King Christian X Hospital for Rheumatic Diseases , South Jutland Hospital , Gråsten , Denmark
| | - K Stengaard-Pedersen
- g Department of Rheumatology , Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - P Junker
- h Department of Rheumatology C , Odense University Hospital , Odense , Denmark
| | - T Ellingsen
- i Diagnostic Centre, Silkeborg Regional Hospital , Silkeborg , Denmark
| | - P Ahlquist
- j Department of Medicine , Vejle Regional Hospital , Vejle , Denmark
| | - H Lindegaard
- h Department of Rheumatology C , Odense University Hospital , Odense , Denmark
| | - A Linauskas
- k Department of Rheumatology , Vendsyssel Hospital , Hjørring , Denmark
| | - A Schlemmer
- l Department of Rheumatology , Aalborg University Hospital , Aalborg , Denmark
| | - M Y Dam
- i Diagnostic Centre, Silkeborg Regional Hospital , Silkeborg , Denmark
| | - I Hansen
- m Department of Rheumatology , Viborg Regional Hospital , Viborg , Denmark
| | - T Lottenburger
- j Department of Medicine , Vejle Regional Hospital , Vejle , Denmark
| | - C Ammitzbøll
- g Department of Rheumatology , Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - A Jørgensen
- g Department of Rheumatology , Aarhus University Hospital, and Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - S B Krintel
- a Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark.,c DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark
| | - J Raun
- f King Christian X Hospital for Rheumatic Diseases , South Jutland Hospital , Gråsten , Denmark
| | - M L Hetland
- a Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark.,b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark.,c DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet , Glostrup , Denmark
| |
Collapse
|
38
|
Controversies in rheumatoid arthritis glucocorticoid therapy. Joint Bone Spine 2018; 85:417-422. [DOI: 10.1016/j.jbspin.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 01/07/2023]
|
39
|
Hyldgaard C, Bendstrup E, Pedersen AB, Ulrichsen SP, Løkke A, Hilberg O, Ellingsen T. Increased mortality among patients with rheumatoid arthritis and COPD: A population-based study. Respir Med 2018; 140:101-107. [PMID: 29957269 DOI: 10.1016/j.rmed.2018.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Only few studies have addressed the prognostic impact of chronic obstructive pulmonary disease (COPD) among patients with rheumatoid arthritis (RA), although both diseases are frequent and smoking is a shared risk factor. The objectives of the present study were to investigate the burden of COPD among RA patients and the subsequent mortality. METHODS We included patients who had a first-time diagnosis of RA in the Danish National Patient Registry between 2004 and 2016. RA patients with COPD were identified and matched with RA patients without COPD for year of birth, gender, and age at RA diagnosis. Mortality risks were assessed using Kaplan-Meier mortality curves. Adjusted hazard rate ratios (aHRRs) for death were estimated using Cox regression models. RESULTS The study population included 31,333 individuals with RA. 3254 of those (10.4%) had a diagnosis of COPD and were matched to 9706 RA patients without COPD. The mortality risks in RA patients with COPD and RA patients without COPD were 4.5% and 1.5% within 2-6 months (aHRR = 3.0, CI 2.3-3.9), and 59.3% and 39.8% within 0.5-10 years (aHRR = 2.1, CI 1.9-2.1). CONCLUSION Mortality was significantly increased among RA patients with COPD. The relative mortality risk remained significantly increased throughout the course of follow up.
Collapse
Affiliation(s)
| | | | | | | | - Anders Løkke
- Department of Respiratory Diseases, Aarhus University Hospital, Denmark
| | - Ole Hilberg
- Department of Medicine, Vejle Hospital, Denmark
| | - Torkell Ellingsen
- Diagnostic Centre, Silkeborg Regional Hospital, Denmark; Department of Rheumatology, Odense University Hospital, Denmark
| |
Collapse
|
40
|
Möller B, Everts-Graber J, Florentinus S, Li Y, Kupper H, Finckh A. Low Hemoglobin and Radiographic Damage Progression in Early Rheumatoid Arthritis: Secondary Analysis From a Phase III Trial. Arthritis Care Res (Hoboken) 2018; 70:861-868. [PMID: 28950430 DOI: 10.1002/acr.23427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/19/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study low blood hemoglobin concentrations as a predictor of radiographic damage progression in patients with rheumatoid arthritis (RA). METHODS Post hoc analyses were performed in patients from the PREMIER trial with early RA undergoing 2 years of adalimumab (ADA), methotrexate (MTX), or ADA + MTX combination therapy. Low disease activity was defined as a score <3.2 on the 28-joint Disease Activity Score using the C-reactive protein level (DAS28-CRP), and clinical response by the American College of Rheumatology criteria for 20% improvement at week 24. Baseline or mean hemoglobin concentrations over time, or anemia as defined using sex-specific World Health Organization criteria, were analyzed in mixed-effects models for longitudinal data in men and women as predictors of progressive joint damage, as measured by the modified total Sharp/van der Heijde score (ΔSHS). Data were adjusted for treatment and other patient characteristics, including the DAS28-CRP. RESULTS Baseline hemoglobin was inversely associated with ΔSHS in adjusted analyses (P < 0.05 for both sexes). Baseline anemia predicted greater ΔSHS in MTX-treated patients over 104 weeks, and in ADA- and combination-treated patients over 26 weeks. Lower hemoglobin concentrations over time, as well as time with anemia, were associated with greater damage progression (P < 0.001). The effect of low hemoglobin concentrations on joint damage progression remained significant, even in patients achieving low disease activity. CONCLUSION Low hemoglobin is a DAS28-CRP-independent predictor of radiographic joint damage progression in MTX-treated patients with early RA. This effect decreases over time in ADA- and combination-treated patients, and in clinical responders irrespective of treatment modality.
Collapse
Affiliation(s)
| | | | | | | | | | - Axel Finckh
- University Hospital of Geneva, Geneva, Switzerland
| |
Collapse
|
41
|
Cai W, Gu Y, Cui H, Cao Y, Wang X, Yao Y, Wang M. The Efficacy and Safety of Mainstream Medications for Patients With cDMARD-Naïve Rheumatoid Arthritis: A Network Meta-Analysis. Front Pharmacol 2018; 9:138. [PMID: 29618976 PMCID: PMC5871709 DOI: 10.3389/fphar.2018.00138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/08/2018] [Indexed: 01/28/2023] Open
Abstract
Background: The mainstream medications for rheumatoid arthritis (RA) include conventional disease-modifying antirheumatic drugs (cDMARDs), which mostly are methotrexate (MTX), and biologic agents such as adalimumab (ADA), certolizumab (CZP), etanercept (ETN), golimumab (GOL), infliximab (IFX), and tocilizumab (TCZ). This network meta-analysis was aimed at evaluating the efficacy and safety of the medications above and interventions combining cDMARDs and biologic agents for patients with RA. Methods: PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched systematically for eligible randomized controlled trials (RCTs). Outcomes concerning efficacy and safety were evaluated utilizing odds ratios (ORs) and 95% credible intervals (CrI). The outcomes of efficacy would be evaluated through remission and American College of Rheumatology (ACR) scores. The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment on each index. Results: A total of 20 RCTs with 9,047 patients were included, and the efficacy and safety of the concerning interventions for RA were evaluated. Compared with cDMARDs alone, TCZ+MTX, ETN+MTX, IFX+MTX, TCZ, and ADA+MTX showed significant statistical advantage on ACR20, ACR50, and ACR70. Apart from that, as for remission, TCZ+MTX, IFX+MTX, TCZ, and CZP+MTX performed better compared to cDMARDs alone. The SUCRA ranking also indicated that TCZ+MTX was the intervention with best ranking in the entire four efficacy indexes followed by ETX+MTX and IFX+MTX. However, there was no obvious difference among these medications compared with cDMARDs when it comes to safety, which need more specific studies on that. Conclusion: TCZ+MTX was potentially the most recommended combination of medications for RA due to its good performance in all outcomes of efficacy. ETX+MTX and IFX+MTX, which also performed well, could be introduced as alternative treatments. However, considering the adverse events, the treatments concerning should be introduced with caution.
Collapse
Affiliation(s)
- Weiyan Cai
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| | - Youyi Gu
- Department of Integrated Chinese and Western Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| | - Huanqin Cui
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| | - Yinyin Cao
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| | - Xiaoliang Wang
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| | - Yi Yao
- Department of Pediatrics, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| | - Mingyu Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital Affiliated to Qingdao Medical College of Qingdao University, Yantai, China
| |
Collapse
|
42
|
Stevenson M, Archer R, Tosh J, Simpson E, Everson-Hock E, Stevens J, Hernandez-Alava M, Paisley S, Dickinson K, Scott D, Young A, Wailoo A. Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for the treatment of rheumatoid arthritis not previously treated with disease-modifying antirheumatic drugs and after the failure of conventional disease-modifying antirheumatic drugs only: systematic review and economic evaluation. Health Technol Assess 2018; 20:1-610. [PMID: 27140438 DOI: 10.3310/hta20350] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increasing disability, reduced quality of life and substantial costs (as a result of both intervention acquisition and hospitalisation). The objective was to assess the clinical effectiveness and cost-effectiveness of seven biologic disease-modifying antirheumatic drugs (bDMARDs) compared with each other and conventional disease-modifying antirheumatic drugs (cDMARDs). The decision problem was divided into those patients who were cDMARD naive and those who were cDMARD experienced; whether a patient had severe or moderate to severe disease; and whether or not an individual could tolerate methotrexate (MTX). DATA SOURCES The following databases were searched: MEDLINE from 1948 to July 2013; EMBASE from 1980 to July 2013; Cochrane Database of Systematic Reviews from 1996 to May 2013; Cochrane Central Register of Controlled Trials from 1898 to May 2013; Health Technology Assessment Database from 1995 to May 2013; Database of Abstracts of Reviews of Effects from 1995 to May 2013; Cumulative Index to Nursing and Allied Health Literature from 1982 to April 2013; and TOXLINE from 1840 to July 2013. Studies were eligible for inclusion if they evaluated the impact of a bDMARD used within licensed indications on an outcome of interest compared against an appropriate comparator in one of the stated population subgroups within a randomised controlled trial (RCT). Outcomes of interest included American College of Rheumatology (ACR) scores and European League Against Rheumatism (EULAR) response. Interrogation of Early Rheumatoid Arthritis Study (ERAS) data was undertaken to assess the Health Assessment Questionnaire (HAQ) progression while on cDMARDs. METHODS Network meta-analyses (NMAs) were undertaken for patients who were cDMARD naive and for those who were cDMARD experienced. These were undertaken separately for EULAR and ACR data. Sensitivity analyses were undertaken to explore the impact of including RCTs with a small proportion of bDMARD experienced patients and where MTX exposure was deemed insufficient. A mathematical model was constructed to simulate the experiences of hypothetical patients. The model was based on EULAR response as this is commonly used in clinical practice in England. Observational databases, published literature and NMA results were used to populate the model. The outcome measure was cost per quality-adjusted life-year (QALY) gained. RESULTS Sixty RCTs met the review inclusion criteria for clinical effectiveness, 38 of these trials provided ACR and/or EULAR response data for the NMA. Fourteen additional trials contributed data to sensitivity analyses. There was uncertainty in the relative effectiveness of the interventions. It was not clear whether or not formal ranking of interventions would result in clinically meaningful differences. Results from the analysis of ERAS data indicated that historical assumptions regarding HAQ progression had been pessimistic. The typical incremental cost per QALY of bDMARDs compared with cDMARDs alone for those with severe RA is > £40,000. This increases for those who cannot tolerate MTX (£50,000) and is > £60,000 per QALY when bDMARDs were used prior to cDMARDs. Values for individuals with moderate to severe RA were higher than those with severe RA. Results produced using EULAR and ACR data were similar. The key parameter that affected the results is the assumed HAQ progression while on cDMARDs. When historic assumptions were used typical incremental cost per QALY values fell to £38,000 for those with severe disease who could tolerate MTX. CONCLUSIONS bDMARDs appear to have cost per QALY values greater than the thresholds stated by the National Institute for Health and Care Excellence for interventions to be cost-effective. Future research priorities include: the evaluation of the long-term HAQ trajectory while on cDMARDs; the relationship between HAQ direct medical costs; and whether or not bDMARDs could be stopped once a patient has achieved a stated target (e.g. remission). STUDY REGISTRATION This study is registered as PROSPERO CRD42012003386. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rachel Archer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Tosh
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Everson-Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Suzy Paisley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kath Dickinson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - David Scott
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Adam Young
- Department of Rheumatology, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
| | - Allan Wailoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
43
|
Brahe CH, Dehlendorff C, Østergaard M, Johansen JS, Ørnbjerg LM, Hørslev-Petersen K, Stengaard-Pedersen K, Junker P, Ellingsen T, Lindegaard H, Hansen I, Lottenburger T, Jacobsen S, Jurik AG, Hetland ML. Circulating serum interleukin-6, serum chitinase-3-like protein-1, and plasma vascular endothelial growth factor are not predictive for remission and radiographic progression in patients with early rheumatoid arthritis: post-hoc explorative and validation studies based on the CIMESTRA and OPERA trials. Scand J Rheumatol 2018; 47:259-269. [PMID: 29336711 DOI: 10.1080/03009742.2017.1376107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate serum interleukin-6 (IL-6), serum chitinase-3-like protein-1 (YKL-40), and plasma vascular endothelial growth factor (VEGF) as measures of disease activity and predictors of clinical remission and radiographic progression in two early rheumatoid arthritis (RA) randomized controlled trials (RCTs). METHOD Treatment-naïve patients with early RA (< 6 months' duration) and active disease, participating in two investigator-initiated RCTs, were treated according to a predefined treat-to-target algorithm aiming at inflammatory control, using methotrexate (MTX) + cyclosporine versus MTX + placebo (CIMESTRA study, n = 150, 5 year follow-up) or MTX + adalimumab versus MTX + placebo (OPERA study, n = 180, 2 year follow-up). The 28-joint Disease Activity Score (DAS28) and conventional radiography [bilateral hands and feet at baseline, 2 years and 5 years (only CIMESTRA)] were obtained at baseline and during follow-up. Serum IL-6, serum YKL-40, and plasma VEGF were measured in baseline blood samples and during follow-up. Hypotheses regarding the biomarkers' relation with DAS28 and ability to predict clinical remission (DAS28 < 2.6) and radiographic progression (change in total Sharp van der Heijde score ≥ 2) were generated in CIMESTRA and validated in OPERA, by Spearman's correlation and logistic regression analyses. RESULTS Baseline IL-6, YKL-40, and VEGF correlated significantly with DAS28 in CIMESTRA (r = 0.50, r = 0.36, r = 0.36, respectively, all p < 0.01) and these results were confirmed in OPERA patients (r = 0.52, p < 0.01; r = 0.18, p = 0.01; r = 0.23, p = 0.002, respectively). None of the biomarkers (absolute values or change) was predictive of clinical remission or radiographic progression at 2 or 5 years in either study. CONCLUSION Serum IL-6, serum YKL-40, and plasma VEGF were significantly correlated with DAS28 at baseline, but did not have consistent predictive value for clinical remission or radiographic progression in two early RA RCTs.
Collapse
Affiliation(s)
- C H Brahe
- a Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark.,b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.,c DANBIO Registry, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark
| | - C Dehlendorff
- d Danish Cancer Society Research Center , Danish Cancer Society , Copenhagen , Denmark
| | - M Østergaard
- a Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark.,b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.,c DANBIO Registry, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark
| | - J S Johansen
- b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.,e Department of Medicine and Oncology, Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | - L M Ørnbjerg
- a Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark.,c DANBIO Registry, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark
| | - K Hørslev-Petersen
- f King Christian X Hospital for Rheumatic Diseases , South Jutland Hospital , Gråsten , Denmark
| | - K Stengaard-Pedersen
- g Department of Rheumatology , Aarhus University Hospital and lnstitute of Clinical Medicine, Aarhus University , Aarhus , Denmark
| | - P Junker
- h Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - T Ellingsen
- i Diagnostic Centre , Silkeborg Regional Hospital , Silkeborg , Denmark
| | - H Lindegaard
- h Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - I Hansen
- j Department of Rheumatology , Viborg Regional Hospital , Viborg , Denmark
| | - T Lottenburger
- k Department of Medicine , Vejle Regional Hospital , Vejle , Denmark
| | - S Jacobsen
- a Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark
| | - A G Jurik
- l Department of Radiology, Aarhus University Hospital and Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - M L Hetland
- a Copenhagen Center for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark.,b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.,c DANBIO Registry, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics , Rigshospitalet , Glostrup , Denmark
| |
Collapse
|
44
|
Sode J, Krintel SB, Carlsen AL, Hetland ML, Johansen JS, Hørslev-Petersen K, Stengaard-Pedersen K, Ellingsen T, Burton M, Junker P, Østergaard M, Heegaard NHH. Plasma MicroRNA Profiles in Patients with Early Rheumatoid Arthritis Responding to Adalimumab plus Methotrexate vs Methotrexate Alone: A Placebo-controlled Clinical Trial. J Rheumatol 2017; 45:53-61. [PMID: 29142030 DOI: 10.3899/jrheum.170266] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim was to identify plasma (i.e., cell-free) microRNA (miRNA) predicting antitumor necrosis and/or methotrexate (MTX) treatment response in patients enrolled in an investigator-initiated, prospective, double-blinded, placebo-controlled trial (The OPERA study, NCT00660647). METHODS We included 180 disease-modifying antirheumatic drug-naive patients with early rheumatoid arthritis (RA) randomized to adalimumab (ADA; n = 89) or placebo (n = 91) in combination with MTX. Plasma samples before and 3 months after treatment initiation were analyzed for 91 specific miRNA by quantitative reverse transcriptase-polymerase chain reaction on microfluidic dynamic arrays. A linear mixed-effects model was used to test for associations between pretreatment miRNA and changes in miRNA expression and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean (28 joints) remission at 3 and 12 months, applying false discovery rate correction for multiple testing. Using leave-one-out cross validation, we built predictive multivariate miRNA models and estimated classification performances using receiver-operating characteristics (ROC) curves. RESULTS In the ADA group, a higher pretreatment level of miR-27a-3p was significantly associated with remission at 12 months. The level decreased in remitting patients between pretreatment and 3 months, and increased in nonremitting patients. No associations were found in the placebo group receiving only MTX. Two multivariate miRNA models were able to predict response to ADA treatment after 3 and 12 months, with 63% and 82% area under the ROC curves, respectively. CONCLUSION We identified miR-27a-3p as a potential predictive biomarker of ACR/EULAR remission in patients with early RA treated with ADA in combination with MTX. We conclude that pretreatment plasma-miRNA profiles may be of predictive value, but the results need confirmation in independent cohorts.
Collapse
Affiliation(s)
- Jacob Sode
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark. .,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital.
| | - Sophine B Krintel
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Anting Liu Carlsen
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Merete L Hetland
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Julia S Johansen
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Kim Hørslev-Petersen
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Kristian Stengaard-Pedersen
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Torkell Ellingsen
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Mark Burton
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Peter Junker
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Mikkel Østergaard
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| | - Niels H H Heegaard
- From the Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen; Department of Rheumatology, Frederiksberg Hospital, Frederiksberg; Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark, Odense; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup; Department of Medicine and Oncology, Herlev and Gentofte Hospital, Herlev; Faculty of Health Sciences, University of Copenhagen, Copenhagen; Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Department of Rheumatology, Aarhus University Hospital, Aarhus; Department of Rheumatology, Odense University Hospital, Odense; Department of Clinical Genetics, Odense University Hospital, Odense; Institute of Clinical Research, University of Southern Denmark, Odense; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,J. Sode, PhD, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, Department of Rheumatology, Frederiksberg Hospital, and Institute of Regional Health Research-Center Sønderjylland, University of Southern Denmark; S.B. Krintel, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; A.L. Carlsen, PhD, Department of Autoimmunology and Biomarkers, Statens Serum Institut; M.L. Hetland, Professor, DMSc, PhD, MD, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics; J.S. Johansen, Professor, DMSc, MD, Department of Medicine and Oncology, Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; K. Hørslev-Petersen, Professor, DMSc, MD, Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases; K. Stengaard-Pedersen, Professor, DMSc, MD, Department of Rheumatology, Aarhus University Hospital; T. Ellingsen, Professor, PhD, MD, Department of Rheumatology, Odense University Hospital; M. Burton, PhD, Department of Clinical Genetics, Odense University Hospital; P. Junker, External Associate Professor, DMSc, MD, Department of Rheumatology C, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark; M. Østergaard, Professor, DMSc, PhD, MD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; N.H. Heegaard, Professor, DMSc, DSc, MD, Department of Autoimmunology and Biomarkers, Statens Serum Institut, and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital
| |
Collapse
|
45
|
Kristensen AM, Stengaard-Pedersen K, Hetland ML, Hørslev-Petersen K, Junker P, Østergaard M, Höllsberg P, Deleuran B, Hvid M. Expression of soluble CD83 in plasma from early-stage rheumatoid arthritis patients is not modified by anti-TNF-α therapy. Cytokine 2017; 96:1-7. [PMID: 28267648 DOI: 10.1016/j.cyto.2017.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/03/2017] [Accepted: 02/17/2017] [Indexed: 01/03/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease which may lead to severe disabilities due to structural joint damage and extraarticular manifestations The dendritic cell marker CD83 belongs to the immunoglobulin superfamily and has previously been associated with autoimmune diseases. In RA the levels of soluble CD83 (sCD83) are elevated in synovial fluid, however little is known about CD83 expression and regulation in RA. Therefore, we studied how CD83 is expressed in RA and further evaluated the effect of anti-TNF-α therapy hereon. Early RA patients were randomized to conventional disease modifying anti-rheumatic drugs with or without additional anti-TNF-α therapy. Rheumatoid arthritis patients had increased levels of sCD83 in plasma compared with healthy volunteers. The increase in sCD83 plasma levels were unaffected by anti-TNF-α therapy. In chronic RA patients the levels of sCD83 were higher in synovial fluid than in plasma, and only a limited amount of membrane bound CD83 expression was detected on the surface of cells from peripheral blood and synovial fluid. Finally, confocal microscopy of RA synovial membranes revealed that CD83 was mainly localized intracellularly in a group of cells with diverse morphology including both antigen-presenting cells and non-antigen-presenting cells. Our findings demonstrate that early-stage RA patients have elevated levels of sCD83 in plasma and that anti-TNF-α treatment has no effect on the sCD83 plasma level. This suggest that in RA patients sCD83 regulation is beyond control of TNF-α.
Collapse
Affiliation(s)
| | - Kristian Stengaard-Pedersen
- Dept. of Rheumatology, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University, Denmark
| | - Merete Lund Hetland
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark; Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kim Hørslev-Petersen
- King Christian 10th Hospital for the Rheumatic Diseases, and University of Southern Denmark, Denmark
| | - Peter Junker
- Dept. of Rheumatology, Odense University Hospital, Denmark
| | - Mikkel Østergaard
- The DANBIO Registry and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark; Dept. of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Bent Deleuran
- Dept. of Biomedicine, Aarhus University, Denmark; Dept. of Rheumatology, Aarhus University Hospital, Denmark
| | - Malene Hvid
- Dept. of Biomedicine, Aarhus University, Denmark; Dept. of Clinical Medicine, Aarhus University, Denmark.
| |
Collapse
|
46
|
Hyldgaard C, Hilberg O, Pedersen AB, Ulrichsen SP, Løkke A, Bendstrup E, Ellingsen T. A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis 2017; 76:1700-1706. [DOI: 10.1136/annrheumdis-2017-211138] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/04/2017] [Accepted: 05/05/2017] [Indexed: 11/03/2022]
|
47
|
Glinatsi D, Baker JF, Hetland ML, Hørslev-Petersen K, Ejbjerg BJ, Stengaard-Pedersen K, Junker P, Ellingsen T, Lindegaard HM, Hansen I, Lottenburger T, Møller JM, Ørnbjerg L, Vestergaard A, Jurik AG, Thomsen HS, Torfing T, Møller-Bisgaard S, Axelsen MB, Østergaard M. Magnetic resonance imaging assessed inflammation in the wrist is associated with patient-reported physical impairment, global assessment of disease activity and pain in early rheumatoid arthritis: longitudinal results from two randomised controlled trials. Ann Rheum Dis 2017; 76:1707-1715. [DOI: 10.1136/annrheumdis-2017-211315] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/02/2017] [Accepted: 05/05/2017] [Indexed: 11/04/2022]
|
48
|
Heftdal LD, Stengaard-Pedersen K, Ørnbjerg LM, Hetland ML, Hørslev-Petersen K, Junker P, Østergaard M, Hvid M, Deleuran B, Møller HJ, Greisen SR. Soluble CD206 plasma levels in rheumatoid arthritis reflect decrease in disease activity. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:385-389. [PMID: 28598681 DOI: 10.1080/00365513.2017.1331462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rheumatoid arthritis (RA) is characterized by chronic joint inflammation and infiltration by activated macrophages. TNFα is a central mediator in this process. The mannose receptor, CD206, is a scavenger receptor expressed by M2A-macrophages and dendritic cells. It is involved in collagen internalization and degradation. The soluble form has been suggested as a biomarker of M2A-macrophage activation. The aim of this study was to investigate sCD206 plasma levels in early RA patients initiating anti-TNFα treatment. Plasma levels of sCD206 were measured by ELISA in samples from 155 early RA patients with an average symptom duration of 3 months. Patients were randomized to 12 months' methotrexate and placebo (PLA) or methotrexate and adalimumab (ADA) treatment, followed by open-label treatment with disease-modifying anti-rheumatic drugs (DMARD) and if needed, ADA. Disease activity was assessed at baseline and after 3, 6, 12 and 24 months. Baseline plasma level of sCD206 in treatment naïve RA patients was 0.33 mg/L (CI: 0.33-0.38 mg/L) corresponding to the upper part of the reference interval for healthy controls (0.10-0.43 mg/L). In the PLA group, sCD206 levels decreased after 3 months, but did not differ from baseline after 6 months. In the ADA group, however, levels remained lower than baseline throughout the treatment period. In conclusion, initially, plasma sCD206 in early RA patients decreased in accordance with disease activity and initiation of DMARD treatment. Treatment with anti-TNFα preserved this decrease throughout the study period.
Collapse
Affiliation(s)
- Line Dam Heftdal
- a Department of Biomedicine , Aarhus University , Aarhus , Denmark
| | | | - Lykke Midtbøll Ørnbjerg
- c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark
| | - Merete Lund Hetland
- c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.,d Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Kim Hørslev-Petersen
- e Department of Rheumatology , Kong Christian 10th Hospital for the Rheumatic Diseases , Graasten , Denmark.,f Institute of Health Research , University of Southern Denmark , Odense , Denmark
| | - Peter Junker
- g Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - Mikkel Østergaard
- c Center for Rheumatology and Spine Diseases , Copenhagen Center for Arthritis Research, Rigshospitalet , Glostrup , Denmark.,d Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Malene Hvid
- a Department of Biomedicine , Aarhus University , Aarhus , Denmark.,h Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Bent Deleuran
- a Department of Biomedicine , Aarhus University , Aarhus , Denmark.,b Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark.,h Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Holger Jon Møller
- i Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Stinne Ravn Greisen
- a Department of Biomedicine , Aarhus University , Aarhus , Denmark.,b Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|
49
|
Østgård RD, Glerup H, Jurik AG, Kragstrup TW, Stengaard-Pedersen K, Hetland ML, Hørslev-Petersen K, Junker P, Deleuran BW. Hepcidin plasma levels are not associated with changes in haemoglobin in early rheumatoid arthritis patients. Scand J Rheumatol 2017; 46:441-445. [PMID: 28482738 DOI: 10.1080/03009742.2017.1286382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE A reduction in haemoglobin level is a frequent complication among rheumatoid arthritis (RA) patients. Hepcidin has been linked to disturbed erythropoiesis. The objective of this study was to investigate the longitudinal changes in hepcidin in patients with early RA. METHOD Hepcidin plasma concentrations were measured by enzyme-linked immunosorbent assay in patients with early RA (n = 80) and healthy volunteers (HV, n = 40). Haemoglobin and other iron-related proteins were also measured. At baseline, all patients had active disease and were treatment naïve. Patients were treated with disease-modifying anti-rheumatic drugs (DMARDs) and with additional adalimumab (ADA, n = 42) or placebo (PLA, n = 38) during 52 weeks, using a treat-to-target strategy, aiming for a 28-joint Disease Activity Score (DAS28) < 3.2. RESULTS At baseline, hepcidin levels [median (interquartile range)] were 9.7 ng/mL (5.2-19.4 ng/mL) in DMARD + ADA and 11.3 ng/mL (5.9-19.1 ng/mL) in DMARD + PLA. Both were significantly higher than seen in HV (6.0 ng/mL (3.3-9.3 ng/mL) (p < 0.001). After 12 months, both treatment regimens resulted in normalization of hepcidin. DAS28 correlated with hepcidin at baseline (r = 0.48, p < 0.001). No correlation was observed between levels of haemoglobin and hepcidin at baseline or during the 52 week follow-up. No change in haemoglobin levels was seen as a function of hepcidin changes. In a mixed statistical model, no single factor was connected with the regulation of haemoglobin in early RA. CONCLUSION The changes in hepcidin were not associated with changes in haemoglobin levels. Thus, hepcidin could not be used as a prognostic marker in patients with early RA.
Collapse
Affiliation(s)
- R D Østgård
- a Diagnostic Centre , Regional Hospital Silkeborg , Silkeborg , Denmark.,b Department of Biomedicine , Aarhus University , Aarhus , Denmark.,c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - H Glerup
- a Diagnostic Centre , Regional Hospital Silkeborg , Silkeborg , Denmark
| | - A G Jurik
- d Department of Radiology , Aarhus University Hospital , Aarhus , Denmark.,e Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - T W Kragstrup
- b Department of Biomedicine , Aarhus University , Aarhus , Denmark
| | - K Stengaard-Pedersen
- c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark.,e Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - M L Hetland
- f Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases , Rigshospitalet Glostrup , Glostrup , Denmark.,g Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - K Hørslev-Petersen
- h Department of Rheumatology, King Christian 10th Hospital for Rheumatic Diseases, Graasten , Denmark and University of Southern Denmark , Odense , Denmark
| | - P Junker
- i Department of Rheumatology , Odense University Hospital , Odense , Denmark
| | - B W Deleuran
- b Department of Biomedicine , Aarhus University , Aarhus , Denmark.,c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark.,e Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| |
Collapse
|
50
|
Singh JA, Hossain A, Mudano AS, Tanjong Ghogomu E, Suarez‐Almazor ME, Buchbinder R, Maxwell LJ, Tugwell P, Wells GA. Biologics or tofacitinib for people with rheumatoid arthritis naive to methotrexate: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2017; 5:CD012657. [PMID: 28481462 PMCID: PMC6481641 DOI: 10.1002/14651858.cd012657] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biologic disease-modifying anti-rheumatic drugs (biologics) are highly effective in treating rheumatoid arthritis (RA), however there are few head-to-head biologic comparison studies. We performed a systematic review, a standard meta-analysis and a network meta-analysis (NMA) to update the 2009 Cochrane Overview. This review is focused on the adults with RA who are naive to methotrexate (MTX) that is, receiving their first disease-modifying agent. OBJECTIVES To compare the benefits and harms of biologics (abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab) and small molecule tofacitinib versus comparator (methotrexate (MTX)/other DMARDs) in people with RA who are naive to methotrexate. METHODS In June 2015 we searched for randomized controlled trials (RCTs) in CENTRAL, MEDLINE and Embase; and trials registers. We used standard Cochrane methods. We calculated odds ratios (OR) and mean differences (MD) along with 95% confidence intervals (CI) for traditional meta-analyses and 95% credible intervals (CrI) using a Bayesian mixed treatment comparisons approach for network meta-analysis (NMA). We converted OR to risk ratios (RR) for ease of interpretation. We also present results in absolute measures as risk difference (RD) and number needed to treat for an additional beneficial or harmful outcome (NNTB/H). MAIN RESULTS Nineteen RCTs with 6485 participants met inclusion criteria (including five studies from the original 2009 review), and data were available for four TNF biologics (adalimumab (six studies; 1851 participants), etanercept (three studies; 678 participants), golimumab (one study; 637 participants) and infliximab (seven studies; 1363 participants)) and two non-TNF biologics (abatacept (one study; 509 participants) and rituximab (one study; 748 participants)).Less than 50% of the studies were judged to be at low risk of bias for allocation sequence generation, allocation concealment and blinding, 21% were at low risk for selective reporting, 53% had low risk of bias for attrition and 89% had low risk of bias for major baseline imbalance. Three trials used biologic monotherapy, that is, without MTX. There were no trials with placebo-only comparators and no trials of tofacitinib. Trial duration ranged from 6 to 24 months. Half of the trials contained participants with early RA (less than two years' duration) and the other half included participants with established RA (2 to 10 years). Biologic + MTX versus active comparator (MTX (17 trials (6344 participants)/MTX + methylprednisolone 2 trials (141 participants))In traditional meta-analyses, there was moderate-quality evidence downgraded for inconsistency that biologics with MTX were associated with statistically significant and clinically meaningful benefit versus comparator as demonstrated by ACR50 (American College of Rheumatology scale) and RA remission rates. For ACR50, biologics with MTX showed a risk ratio (RR) of 1.40 (95% CI 1.30 to 1.49), absolute difference of 16% (95% CI 13% to 20%) and NNTB = 7 (95% CI 6 to 8). For RA remission rates, biologics with MTX showed a RR of 1.62 (95% CI 1.33 to 1.98), absolute difference of 15% (95% CI 11% to 19%) and NNTB = 5 (95% CI 6 to 7). Biologics with MTX were also associated with a statistically significant, but not clinically meaningful, benefit in physical function (moderate-quality evidence downgraded for inconsistency), with an improvement of HAQ scores of -0.10 (95% CI -0.16 to -0.04 on a 0 to 3 scale), absolute difference -3.3% (95% CI -5.3% to -1.3%) and NNTB = 4 (95% CI 2 to 15).We did not observe evidence of differences between biologics with MTX compared to MTX for radiographic progression (low-quality evidence, downgraded for imprecision and inconsistency) or serious adverse events (moderate-quality evidence, downgraded for imprecision). Based on low-quality evidence, results were inconclusive for withdrawals due to adverse events (RR of 1.32, but 95% confidence interval included possibility of important harm, 0.89 to 1.97). Results for cancer were also inconclusive (Peto OR 0.71, 95% CI 0.38 to 1.33) and downgraded to low-quality evidence for serious imprecision. Biologic without MTX versus active comparator (MTX 3 trials (866 participants)There was no evidence of statistically significant or clinically important differences for ACR50, HAQ, remission, (moderate-quality evidence for these benefits, downgraded for imprecision), withdrawals due to adverse events,and serious adverse events (low-quality evidence for these harms, downgraded for serious imprecision). All studies were for TNF biologic monotherapy and none for non-TNF biologic monotherapy. Radiographic progression was not measured. AUTHORS' CONCLUSIONS In MTX-naive RA participants, there was moderate-quality evidence that, compared with MTX alone, biologics with MTX was associated with absolute and relative clinically meaningful benefits in three of the efficacy outcomes (ACR50, HAQ scores, and RA remission rates). A benefit regarding less radiographic progression with biologics with MTX was not evident (low-quality evidence). We found moderate- to low-quality evidence that biologic therapy with MTX was not associated with any higher risk of serious adverse events compared with MTX, but results were inconclusive for withdrawals due to adverse events and cancer to 24 months.TNF biologic monotherapy did not differ statistically significantly or clinically meaningfully from MTX for any of the outcomes (moderate-quality evidence), and no data were available for non-TNF biologic monotherapy.We conclude that biologic with MTX use in MTX-naive populations is beneficial and that there is little/inconclusive evidence of harms. More data are needed for tofacitinib, radiographic progression and harms in this patient population to fully assess comparative efficacy and safety.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical CenterDepartment of MedicineFaculty Office Tower 805B510 20th Street SouthBirminghamALUSA35294
| | - Alomgir Hossain
- University of Ottawa Heart InstituteCardiovascular Research Methods Centre40 Ruskin StreetRoom H‐2265OttawaONCanadaK1Y 4W7
| | - Amy S Mudano
- University of Alabama at BirminghamDepartment of Medicine ‐ RheumatologyBirminghamUSA
| | | | - Maria E Suarez‐Almazor
- The University of Texas, MD Anderson Cancer CenterDepartment of General Internal Medicine1515 Holcombe BlvdUnit 1465HoustonTexasUSA77030
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Lara J Maxwell
- Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital ‐ General CampusCentre for Practice‐Changing Research (CPCR)501 Smyth Road, Box 711OttawaONCanadaK1H 8L6
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | | |
Collapse
|