1
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Sepriano A, Ramiro S, Landewé R, van der Heijde D, Ohrndorf S, FitzGerald O, Backhaus M, Larché M, Homik J, Saraux A, Hammer HB, Terslev L, Østergaard M, Burmester G, Combe B, Dougados M, Hitchon C, Boire G, Lambert RG, Dadashova R, Paschke J, Hutchings EJ, Maksymowych WP. Adding ultrasound to treat-to-target shows no benefit in achieving clinical remission nor in slowing radiographic progression in rheumatoid arthritis: results from a multicenter prospective cohort. Clin Rheumatol 2024; 43:1833-1844. [PMID: 38684600 DOI: 10.1007/s10067-024-06978-5] [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: 02/14/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To assess whether using ultrasound (US) in addition to clinical information versus only clinical information in a treat-to-target (T2T) strategy leads to more clinical remission and to less radiographic progression in RA. METHODS Patients with RA from the 2-year prospective BIODAM cohort were included. Clinical and US data (US7-score) were collected every 3 months and hands and feet radiographs every 6 months. At each visit, it was decided whether patients were treated according to the clinical definition of T2T with DAS44 remission as benchmark (T2T-DAS44). T2T-DAS44 was correctly applied if: (i) DAS44 remission had been achieved or (ii) if not, treatment was intensified. A T2T strategy also considering US data (T2T-DAS44-US) was correctly applied if: (i) both DAS44 and US remission (synovitis-score < 2, Doppler-score = 0) were present; or (ii) if not, treatment was intensified. The effect of T2T-DAS44-US on attaining clinical remission and on change in Sharp-van der Heijde score compared to T2T-DAS44 was analysed. RESULTS A total of 1016 visits of 128 patients were included. T2T-DAS44 was correctly followed in 24% of visits and T2T-DAS44-US in 41%. DAS44 < 1.6 was achieved in 39% of visits. Compared to T2T-DAS44, using the T2T-DAS44-US strategy resulted in a 41% lower likelihood of DAS44 remission [OR (95% CI): 0.59 (0.40;0.87)] and had no effect on radiographic progression [β(95% CI): 0.11 (- 0.16;0.39)] assessed at various intervals up to 12 months later. CONCLUSION Our results do not suggest a benefit of using the US7-score in addition to clinical information as a T2T benchmark compared to clinical information alone. Key Points • Ultrasound has a valuable role in diagnostic evaluation of rheumatoid arthritis, but it is unclear whether adding ultrasound to the clinical assessment in a treat-to-target (T2T) strategy leads to more patients achieving remission and reduction in radiographic progression. • Our data from a real-world study demonstrated that adding information from ultrasound to the clinical assessment in a T2T strategy led to a lower rather than a higher likelihood of obtaining clinical remission as compared to using only clinical assessment. • Our data demonstrated that adding ultrasound data to a T2T strategy based only on clinical assessment did not offer additional protection against radiographic progression in patients with RA. • Adding US to a T2T strategy based on clinical assessment led to far more treatment intensifications (with consequences for costs and exposure to adverse events) without yielding a meaningful clinical benefit.
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Affiliation(s)
- Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Zuyderland Medical Center, Heerlen, The Netherlands
- Amsterdam University Medical Center (ARC), Amsterdam, The Netherlands
| | | | - Sarah Ohrndorf
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Academic Hospital of Charité - Universitätsmedizin Berlin, Parkklinik Weissensee, Berlin, Germany
| | - Olivier FitzGerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maggie Larché
- Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | - Joanne Homik
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada
| | - Alain Saraux
- LBAI, U1227, University of Brest, Inserm; CHRU Brest, F-29200, Brest, France
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernard Combe
- Departement de Rhumatologie, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Carol Hitchon
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gilles Boire
- Division of Rheumatology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Université de Sherbrooke, Québec, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
- Medical Imaging Consultants, Edmonton, Canada
| | | | | | | | - Walter P Maksymowych
- Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, T6G 2S2, Canada.
- CARE ARTHRITIS LTD, Edmonton, Canada.
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Zanetti A, Zambon A, Scirè CA, Bugatti S, Montecucco C, Sakellariou G. Impact of csDMARDs adherence on clinical remission in patients with new-onset inflammatory arthritis: a prospective cohort study from the ELECTRA database. Ther Adv Musculoskelet Dis 2023; 15:1759720X231194179. [PMID: 37807981 PMCID: PMC10552453 DOI: 10.1177/1759720x231194179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Major improvements in the management of rheumatoid arthritis (RA) have made clinical remission an achievable and desirable goal but, despite the relevance gained by a profound disease suppression, many patients with RA still miss clinical remission due to several factors influencing disease activity, including treatment adherence. Objective To evaluate the effect of adherence to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) on the achievement of clinical remission in a cohort of patients with new-onset inflammatory arthritis. Study design A prospective cohort study was conducted using the ELECTRA database, which consists of clinical data from patients followed at the IRCCS Policlinico San Matteo Foundation (Pavia, Italy), linked to regional administrative healthcare databases. Methods We enrolled patients with new-onset active disease between January 2006 and December 2013 and followed them until their first clinical remission or end of follow-up (December 2015). To assess the association of csDMARD adherence with clinical remission, we estimated the csDMARD proportion of days covered (PDC) during follow-up. PDC was added to the main clinical adjustment covariates as a time-dependent variable in a proportional hazard Cox regression model. Results The cohort included 324 patients with a mean (SD) age of 58 (13.9) and predominantly female (74.5%). A total of 219 patients (67.6%) achieved clinical remission during follow-up and 85 (26.2%) in the first 6 months (early clinical remission). Cox regression models showed that a 10% increment of PDC increased the probability of achieving clinical remission by 10% (p < 0.001) and the probability of early clinical remission by 21% (p = 0.03). Conclusion Patients at disease onset with higher adherence to csDMARDs were more likely to achieve clinical remission and early clinical remission. Our study highlighted the importance of close monitoring of patients to increase their likelihood of following therapeutic indications and achieving favorable disease outcomes, such as lower disability.
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Affiliation(s)
- Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Carlo A. Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Istituti Clinici Scientifici Maugeri IRCCS, via Salvatore Maugeri 10, 27100 Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
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Ramiro S, Landewé R, van der Heijde D, Sepriano A, FitzGerald O, Østergaard M, Homik J, Elkayam O, Thorne JC, Larché MJ, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM. Rheumatology (Oxford) 2023; 62:2989-2997. [PMID: 36645243 DOI: 10.1093/rheumatology/kead021] [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: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. METHODS Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. RESULTS In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: -0.04, 0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. CONCLUSIONS In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NOVA Medical School, Universidade Nova de Lisboa, Portugal
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Ireland
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- The Arthritis Program Research Group, University of Toronto, Toronto, Canada
| | - Maggie J Larché
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunology and Allergy, McMaster University, Hamilton, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), University of Sherbrooke, Sherbrooke, Canada
| | - Bernard Combe
- Department of Rheumatology, Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, France
| | - Alain Saraux
- LBAI, U1227, Université Brest, Inserm, CHU Brest, Brest, France
| | - Maxime Dougados
- Rheumatology Department, Paris Cité University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, CHU Toulouse, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
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Mohamed Mohamed K, Álvarez-Hernández MP, Jiménez García C, Guevara-Hoyer K, Freites D, Martínez Prada C, Pérez-Sancristóbal I, Fernández Gutiérrez B, Mato Chaín G, Rodero M, Rodríguez de la Peña A, Mulero T, Bravo C, Toledano E, Culebras López E, Mediero Valeros B, Pérez Segura P, Sánchez-Ramón S, Candelas Rodríguez G. Specific Cellular and Humoral Response after the Third Dose of Anti-SARS-CoV-2 RNA Vaccine in Patients with Immune-Mediated Rheumatic Diseases on Immunosuppressive Therapy. Biomedicines 2023; 11:2418. [PMID: 37760858 PMCID: PMC10525269 DOI: 10.3390/biomedicines11092418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Data on cellular and humoral immunogenicity after the third dose of anti-SARS-CoV-2 vaccines in patients with immune-mediated rheumatic diseases (IMRDs) are scarce. Herein, we evaluated the adaptive immune response in IMRD patients treated with different immunosuppressive therapies (conventional synthetic disease-modifying antirheumatic drugs [csDMARDs], biological disease-modifying antirheumatic drugs [bDMARDs], and targeted synthetic disease-modifying antirheumatic drugs [tsDMARDs]) after the booster of the anti-SARS-CoV-2 vaccine to determine whether any drug reduced the vaccine's response. METHODS A single-center prospective study was conducted, including patients presenting with IMRD and healthy controls (HC). Specific anti-SARS-CoV-2 interferon-gamma (IFN-γ) production was evaluated between 8-12 weeks after the third dose of the SARS-CoV-2 vaccine. In addition, anti-Spike IgG antibody titers were also measured. RESULTS Samples were obtained from 79 IMRD patients (51 women, 28 men; mean age 57 ± 11.3 years old): 43 rheumatoid arthritis, 10 psoriatic arthritis, 14 ankylosing spondylitis, 10 undifferentiated spondyloarthritis, and 2 inflammatory bowel disease-associated spondyloarthritis (IBD-SpA). In total, 31 HC (mean age 50.9 ± 13.1 years old, 67.7% women) were included in the study. Post-vaccine results displayed positive T-cell immune responses in 68 out of 79 (86.1%) IMRD patients (82.3% of those without prior COVID-19). All HC and IMRDs patients had an antibody response against the SARS-CoV-2 receptor-binding domain; however, the HC response was significantly higher (median of 18,048 AU/mL) than in IMRDs patients (median of 6590.3 AU/mL, p < 0.001). MTX and leflunomide were associated with lower titers of IgG and IFN-γ responses. Among bDMARDs, adalimumab, etanercept, and guselkumab are associated with reduced cellular responses. CONCLUSION Our preliminary data show that the majority of our IMRD patients develop cellular and humoral responses after the SARS-CoV-2 booster vaccination, emphasizing the relevance of vaccination in this group. However, the magnitude of specific responses was dependent on the immunosuppressive therapy administered. Specific vaccination protocols and personalized decisions about boosters are essential for these patients.
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Affiliation(s)
- Kauzar Mohamed Mohamed
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain
| | - María Paula Álvarez-Hernández
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Carlos Jiménez García
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain
| | - Kissy Guevara-Hoyer
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain
| | - Dalifer Freites
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Cristina Martínez Prada
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Inés Pérez-Sancristóbal
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Benjamín Fernández Gutiérrez
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Gloria Mato Chaín
- Unidad de Vacunación del Adulto, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Maria Rodero
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Antonia Rodríguez de la Peña
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain
| | - Teresa Mulero
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Cecilia Bravo
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Esther Toledano
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Esther Culebras López
- Department of Microbiology, IML and IdISSC, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Beatriz Mediero Valeros
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain
| | - Pedro Pérez Segura
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, 28040 Madrid, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdISSC, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, S/N, 28040 Madrid, Spain
| | - Gloria Candelas Rodríguez
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Seet D, Yeo SI, Aw MH, Dhanasekaran P, Mui-San Lim R, Koh LW, Lahiri M. Smoking, but not use of complementary and alternative medicine predicts residual functional disability in patients with inflammatory arthritis on biologic disease-modifying anti-rheumatic drugs: Results from the Singapore National Biologics Register. Int J Rheum Dis 2023; 26:510-518. [PMID: 36737417 DOI: 10.1111/1756-185x.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/09/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
AIMS To describe inflammatory arthritis (IA) patients initiating biologic disease-modifying anti-rheumatic drugs (bDMARDs) who use complementary and alternative medicine (CAM), and determine the impact of CAM on predicting modified Health Assessment Questionnaire (mHAQ) at 6 months. METHODS This was a prospective inception cohort study of patients ≥21 years old initiating a bDMARD for IA after July 2016. Data were obtained via questionnaires and abstraction from medical records. Baseline characteristics between ever-CAM and CAM non-users were compared. CAM as a predictor of mHAQ ≥1 at 6 months after bDMARD initiation was analyzed using multivariate logistic regression, adjusting for other baseline characteristics. RESULTS We recruited 299 patients (36.2% male, mean age 49.0 years). There were 45.8% who had rheumatoid arthritis, 54.2% had a spondyloarthropathy, median disease duration of 1.1 years and median mHAQ of 0.4. Compared to CAM non-users, ever-CAM users had a lower mean body mass index, were less likely to speak English, and more likely to smoke and drink alcohol. There was no association of CAM use with high mHAQ and no interaction with smoking. Smoking (odds ratio [OR] 938.9; 95% CI 3.20-275 884.1), baseline mHAQ (OR 252.2; 95% CI 5.34-11 899.2) and Charlson's Comorbidity Index score ≥4 (OR 237.4; 95% CI 1.22-46 184.4) independently predicted high mHAQ at 6 months. CONCLUSIONS CAM use was not associated with high mHAQ at 6 months. Smoking was an independent predictor of residual functional disability at 6 months, even after adjusting for age, comorbidity and baseline mHAQ. Greater emphasis on smoking cessation may improve long-term functional outcomes in IA patients on bDMARDs.
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Affiliation(s)
- Dominic Seet
- Department of General Medicine, Sengkang General Hospital, Singapore City, Singapore
| | - Siaw Ing Yeo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Man Hua Aw
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Preeti Dhanasekaran
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Rosa Mui-San Lim
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Li Wearn Koh
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Manjari Lahiri
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Division of Rheumatology, Department of Medicine, National University Hospital, Singapore City, Singapore
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England BR, Yun H, Chen L, Vanderbleek J, Michaud K, Mikuls TR, Curtis JR. Influence of Multimorbidity on New Treatment Initiation and Achieving Target Disease Activity Thresholds in Active Rheumatoid Arthritis: A Cohort Study Using the Rheumatology Informatics System for Effectiveness Registry. Arthritis Care Res (Hoboken) 2023; 75:231-239. [PMID: 34338449 PMCID: PMC8807743 DOI: 10.1002/acr.24762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether multimorbidity is associated with treatment changes and achieving target disease activity thresholds in patients with active rheumatoid arthritis (RA). METHODS We conducted a retrospective cohort study of adults with active RA within the Rheumatology Informatics System for Effectiveness (RISE) registry. Multimorbidity was measured using RxRisk, a medication-based index of chronic disease. We used multivariable logistic regression models to assess the associations of multimorbidity with the odds of initiating a new disease-modifying antirheumatic drug (DMARD) in active RA, and among those initiating a new DMARD, the odds of achieving low disease activity or remission. RESULTS We identified 15,626 patients using the Routine Assessment of Patient Index Data 3 (RAPID3) cohort and 5,733 patients using the Clinical Disease Activity Index (CDAI) cohort. All patients had active RA, of which 1,558 (RAPID3) and 834 (CDAI) initiated a new DMARD and had follow-up disease activity measures. Patients were middle aged, female, and predominantly White, and on average received medications from 6 to 7 RxRisk categories. Multimorbidity was not associated with new DMARD initiation in active RA. However, a greater burden of multimorbidity was associated with lower odds of achieving treatment targets (per 1-unit RxRisk: RAPID3 cohort odds ratio [OR] 0.95 [95% confidence interval (95% CI) 0.91, 0.98]; CDAI cohort OR 0.94 [95% CI 0.90, 0.99]). Those with the highest burden of multimorbidity had the lowest odds of achieving target RA disease activity (RAPID3 cohort OR 0.54 [95% CI 0.34, 0.85]; CDAI cohort OR 0.65 [95% CI 0.37, 1.15]). CONCLUSION These findings from a large, real-world registry illustrate the potential impact of multimorbidity on treatment response and indicate that a more holistic management approach targeting multimorbidity may be needed to optimize RA disease control in these patients.
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Affiliation(s)
- Bryant R. England
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center & VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | - Huifeng Yun
- University of Alabama at Birmingham, Birmingham, AL
| | - Lang Chen
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Kaleb Michaud
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center & VA Nebraska-Western Iowa Health Care System, Omaha, NE
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS
| | - Ted R. Mikuls
- Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center & VA Nebraska-Western Iowa Health Care System, Omaha, NE
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Zhao JL, Liu X, Nan Li J, Ru Liu M, Rottier E, Zhao Y, Zeng XF. Implementation of the treat-to-target approach and treatment satisfaction in patients with rheumatoid arthritis: perspectives of Chinese rheumatologists. Clin Rheumatol 2022; 41:2659-2668. [PMID: 35579773 DOI: 10.1007/s10067-022-06187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 03/30/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the implementation of treat-to-target (T2T) and treatment satisfaction from Chinese rheumatologists' perspectives. METHODS This retrospective analysis of a cross-sectional database collected from rheumatologists and their adult patients with RA in China using Adelphi Real World Disease Specific Programme™ methodology. Multivariate logistic regression models were used to evaluate factors associated with T2T use, achievement of T2T goals, and physician treatment satisfaction. RESULTS Sixty physicians provided data for 600 patients, of whom 39.0% (234/600) were being treated using T2T, and 64.9% (366/564) had achieved their T2T goal. Physicians were satisfied with treatment in 74.3% (445/599) of patients. Patients with a higher pain score were more likely to be managed using T2T (odds ratio (OR) 1.25; p = 0.017), but less likely to have achieved the T2T goal (OR 0.76; p = 0.004). T2T use was more likely if patients had a longer time since diagnosis (> 2 vs ≤ 2 years; OR 1.61; p = 0.031) or received targeted synthetic or biologic disease-modifying antirheumatic drugs (tsDMARDs or bDMARDs; OR 6.90; p < 0.001). T2T goal achievement was more likely for patients with higher body mass index (≥ 24 vs < 24 kg/m2; OR 2.73; p = 0.001) or full-time employment (OR 2.11; p = 0.005). Physician treatment satisfaction was more likely if the T2T goal was achieved (OR 4.78; p < 0.001) or tsDMARDs or bDMARDs were used (OR 2.58; p = 0.017), and less likely if pain scores were higher (OR 0.79; p = 0.019). CONCLUSIONS T2T implementation in China is suboptimal. Our findings provide insight into T2T implementation and physician treatment satisfaction, supporting T2T use in Chinese RA clinical practice. Key Points • T2T implementation in China is currently suboptimal. • Patients with greater pain were more likely to be managed using T2T but were less likely to have achieved their T2T goals. • Physician treatment satisfaction was associated with T2T goal achievement.
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Affiliation(s)
- Jiu Liang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. .,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. .,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xin Liu
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Jin Nan Li
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Meng Ru Liu
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, China
| | - Elke Rottier
- Autoimmune Franchise, Adelphi Real World, Bollington, Cheshire, UK
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiao Feng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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8
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Huang H, Xie W, Geng Y, Fan Y, Wang Y, Zhao J, Zhang Z. Towards a Better Implementation of Treat-to-Target Strategy in Rheumatoid Arthritis: A Comparison of Two Real-World Cohorts. Rheumatol Ther 2022; 9:907-917. [PMID: 35347662 PMCID: PMC8960103 DOI: 10.1007/s40744-022-00441-0] [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: 01/07/2022] [Accepted: 03/04/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Treat-to-target (T2T) strategy has been the core of rheumatoid arthritis (RA) management for over a decade, although it implementation has varied distinctly in real practices. We report here our investigation of the differences in disease activity and target achievement of two patient cohorts with different T2T implementations. Methods Data of the CENTRA (Collaboratively intENsive Treat-to-target in RA) and TARRA (Treat-to-TARget in RA) cohorts were used. The CENTRA cohort is a RA cohort prospectively followed up by a fixed team with tight control, while the TARRA is a longitudinal observational cohort followed up by a rheumatologist with casual control. Patients from the two cohorts were matched 1:3 by propensity score matching. The primary outcome was the Simplified Disease Activity Index (SDAI) at the 1-year follow-up. Results Included in this analysis were 102 patients from the CENTRA cohort and 271 patients from the TARRA cohort. Both groups were comparable in terms of age, gender, disease course, and seropositivity. At the end of the 1-year follow-up, the SDAI of patients in the CENTRA cohort was significantly lower than that of patients in the TARRA cohort (2.1 vs. 3.4; p < 0.001). A similar result was obtained based on the generalized estimating equation (GEE) model (p = 0.009). In addition, more patients in the CENTRA cohort achieved SDAI-defined remission compared to the TARRA cohort [72 (70.6%) vs. 134 (49.4%); p < 0.001]. Conclusion Patients with RA may benefit more from a tight control T2T strategy with closer follow-up and appropriate education compared with those with a casual T2T strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00441-0.
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Affiliation(s)
- Hong Huang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Wenhui Xie
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yong Fan
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, 100034, China.
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9
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AlOmair M, AlMalki H, AlShamrani N, Habtar G, AlAsmari M, Mobasher W, AlQahtani H, Rahman A, Asiri A. Patterns of Response to Different Treatment Strategies in Seropositive Rheumatoid Arthritis Patients in a Tertiary Hospital in South-Western Saudi Arabia: A Retrospective Study. Open Access Rheumatol 2021; 13:239-246. [PMID: 34429668 PMCID: PMC8374534 DOI: 10.2147/oarrr.s322833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the pattern of response to different treatment strategies in seropositive rheumatoid arthritis (RA) patients and to describe our clinical practice in RA management. Patients and Methods Over a period of two years from April 2018 to April 2020, we conducted a retrospective analysis of data for 288 consecutive seropositive RA patients attending rheumatology clinics and the daycare unit at Aseer Central Hospital. Data were collected on patient demographics, disease duration, extraarticular manifestations, comorbidities and treatment. Disease activity was assessed using the clinical disease activity index (CDAI). Results Out of the total 288 patients, 42% (120) are on csDMRADs, while 54% (162) are on bDMRADs and 4% (6) are on tsDMARDs. Of the patients on csDMARDS, 51%, 43% and 7% of them were on remission, low and moderate disease activity, respectively. However, of the patients on non-csDMARDS, 36.3%, 49.4% and 14.3% of them were on remission, low and moderate disease activity, respectively. Failure of csDMARDs was affected by the presence of high disease activity at baseline, extraarticular lung manifestations and coexistent fibromyalgia, with a significant effect of the latter on remission rate. Among patients on non-csDMARDs, 42 (25%) showed one or more therapy changes. Tumor necrosis factor inhibitors were the predominant first-line agents in biologically naive patients (65%) followed by abatacept (18%). Abatacept was the most frequently prescribed second biologic in 52% of cases followed by tocilizumab in 19%. Conclusion The current clinical practice in our hospital is consistent with the latest American College of Rheumatology (ACR)/The European League Against Rheumatism (EULAR) guidelines. Treat-to-target strategy was achieved in the vast majority of our patients, while remission was observed in almost half of the patients.
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Affiliation(s)
- Mohammed AlOmair
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Hanan AlMalki
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Nouf AlShamrani
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Ghadah Habtar
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Maram AlAsmari
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Wejdan Mobasher
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Hanan AlQahtani
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Aydah Rahman
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Alhussain Asiri
- Division of Rheumatology, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
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10
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Subash M, Liu LH, DeQuattro K, Choden S, Jacobsohn L, Katz P, Bajaj P, Barton JL, Bartels C, Bermas B, Danila MI, Downey C, Ferguson S, Reiter K, Wahl E, Weinstein E, Zell J, Schmajuk G, Yazdany J. The Development of the Rheumatology Informatics System for Effectiveness Learning Collaborative for Improving Patient-Reported Outcome Collection and Patient-Centered Communication in Adult Rheumatology. ACR Open Rheumatol 2021; 3:690-698. [PMID: 34288595 PMCID: PMC8516100 DOI: 10.1002/acr2.11310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Patient‐reported outcomes (PROs) are an integral part of treat‐to‐target approaches in managing rheumatoid arthritis (RA). In clinical practice, however, routine collection, documentation, and discussion of PROs with patients are highly variable. The RISE LC (Rheumatology Informatics System for Effectiveness Learning Collaborative) was established to develop and share best practices in PRO collection and use across adult rheumatology practices in the United States Methods The goals of the RISE LC were developed through site surveys and in‐person meetings. Participants completed a baseline survey on PRO collection and use in their practices. RISE LC learning sessions focused on improving communication around PROs with patients and enhancing shared decision‐making in treatment plans. During the coronavirus disease 2019 (COVID‐19) pandemic, the RISE LC pivoted to adapt PRO tools for telehealth. Results At baseline, all responding sites (n = 15) had established workflows for collecting PROs. Most sites used paper forms alone. PRO documentation in electronic health records was variable, with only half of the sites using structured data fields. To standardize and improve the use of PROs, participants iteratively developed a Clinical Disease Activity Index–based RA Disease Activity Communication Tool to solicit treatment goals and improve shared decision‐making across sites. The COVID‐19 pandemic necessitated developing a tool to gauge PROs via telehealth. Conclusion The RISE LC is a continuous, structured method for implementing strategies to improve PRO collection and use in rheumatological care, initially adapting from the Learning Collaborative model and extending to include features of a learning network. Future directions include measuring the impact of standardized PRO collection and discussion on shared decision‐making and RA outcomes.
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Affiliation(s)
| | - Lucy H Liu
- Kaiser Permanente Northern California, Oakland
| | | | - Sonam Choden
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Lindsay Jacobsohn
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | | | | | | | | | | | | | | | | | - Kimberly Reiter
- Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, New Mexico
| | | | | | | | | | - Jinoos Yazdany
- Zuckerberg San Francisco General Hospital, San Francisco, California
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11
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Boers M. Patient global assessment to define remission in rheumatoid arthritis:quo vadis? Ann Rheum Dis 2020; 80:277-279. [PMID: 33158884 DOI: 10.1136/annrheumdis-2020-218802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Maarten Boers
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands .,Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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12
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Ziade N, El Khoury B, Zoghbi M, Merheb G, Abi Karam G, Mroue' K, Messaykeh J. Prevalence and pattern of comorbidities in chronic rheumatic and musculoskeletal diseases: the COMORD study. Sci Rep 2020; 10:7683. [PMID: 32376850 PMCID: PMC7203228 DOI: 10.1038/s41598-020-64732-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/21/2020] [Indexed: 02/08/2023] Open
Abstract
Increased risk of comorbidities has been reported in Rheumatic and Musculoskeletal Diseases (RMD). We aimed to evaluate the prevalence and pattern of comorbidities in RMD patients nationwide, to identify multimorbidity clusters and to evaluate the gap between recommendations and real screening. Cross-sectional, multicentric nationwide study. Prevalence of comorbidities was calculated according to six EULAR axes. Latent Class Analysis identified multimorbidity clusters. Comorbidities' screening was compared to international and local recommendations. In 769 patients (307 RA, 213 OA, 63 SLE, 103 axSpA, and 83 pSA), the most frequent comorbidities were cardiovascular risk factors and diseases (CVRFD) (hypertension 36.5%, hypercholesterolemia 30.7%, obesity 22.7%, smoking 22.1%, diabetes 10.4%, myocardial infarction 6.6%), osteoporosis (20.7%) and depression (18.1%). Three clusters of multimorbidity were identified: OA, RA and axSpA. The most optimal screening was found for CVRF (> = 93%) and osteoporosis (53%). For malignancies, mammograms were the most optimally prescribed (56%) followed by pap smears (32%) and colonoscopy (21%). Optimal influenza and pneumococcus vaccination were found in 22% and 17%, respectively. Comorbidities were prevalent in RMD and followed specific multimorbidity patterns. Optimal screening was adequate for CVRFD but suboptimal for malignant neoplasms, osteoporosis, and vaccination. The current study identified health priorities, serving as a framework for the implementation of future comorbidity management standardized programs, led by the rheumatologist and coordinated by specialized health care professionals.
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Affiliation(s)
- Nelly Ziade
- Rheumatology department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
- Rheumatology department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
| | - Bernard El Khoury
- Gastro-enterology department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Marouan Zoghbi
- Family Medicine department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Merheb
- Notre-Dame des Secours University Hospital, Jbeil, Lebanon
- Holy Spirit University Kaslik, Jounieh, Lebanon
| | - Ghada Abi Karam
- Rheumatology department, Hotel-Dieu de France Hospital, Beirut, Lebanon
- Rheumatology department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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13
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Ramiro S, Landewé RB, van der Heijde D, Sepriano A, FitzGerald O, Ostergaard M, Homik J, Elkayam O, Thorne JC, Larche M, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Rossini M, Govoni M, Sinigaglia L, Cantagrel AG, Allaart CF, Barnabe C, Bingham CO, Tak PP, van Schaardenburg D, Hammer HB, Dadashova R, Hutchings E, Paschke J, Maksymowych WP. Is treat-to-target really working in rheumatoid arthritis? a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM). Ann Rheum Dis 2020; 79:453-459. [PMID: 32094157 DOI: 10.1136/annrheumdis-2019-216819] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target. METHODS RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models. RESULTS In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52). CONCLUSION In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Robert Bm Landewé
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
| | | | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Oliver FitzGerald
- St Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ori Elkayam
- Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Carter Thorne
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Larche
- Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunolgoy and Allergy, McMaster University, Hamilton, Ontario, Canada
| | | | - Marina Backhaus
- Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany
| | - Gilles Boire
- Department of Medicine/Division of Rheumatology, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Bernard Combe
- CHU Montpellier and Montpellier University, Montpellier, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, Bordeaux, France
| | | | - Maxime Dougados
- Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marcello Govoni
- Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Luigi Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Alain G Cantagrel
- Department of Rheumatology, Paul Sabatier University, Toulouse, France
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Paul P Tak
- Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands.,Department of Rheumatology, Ghent University, Ghent, Belgium.,Department of Medicine, Cambridge University, Cambridge, United Kingdom
| | | | | | | | | | - Joel Paschke
- CaRE Arthritis LTD, University of Alberta, Edmonton, Alberta, Canada
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14
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Norvang V, Brinkmann GH, Yoshida K, Lillegraven S, Aga AB, Sexton J, Tedeschi SK, Lyu H, Norli ES, Uhlig T, Kvien TK, Mjaavatten MD, Solomon DH, Haavardsholm EA. Achievement of remission in two early rheumatoid arthritis cohorts implementing different treat-to-target strategies. Arthritis Rheumatol 2020; 72:1072-1081. [PMID: 32090491 DOI: 10.1002/art.41232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare achievement of remission in two early rheumatoid arthritis (RA) treat-to-target (TTT) cohorts, one tight control cohort targeting stringent remission in a randomized controlled strategy trial and one observational cohort targeting a looser definition of remission in clinical practice. METHODS We analyzed data from the ARCTIC trial and the NOR-VEAC observational study. Both were Norwegian multicenter studies including disease modifying anti-rheumatic drug (DMARD)-naïve RA-patients and implementing TTT. The target in ARCTIC was remission defined as a Disease Activity Score (DAS44) <1.6 plus 0 of 44 swollen joint count, while the target in NOR-VEAC was the less stringent remission of DAS28<2.6. We assessed achievement of the study-specific targets and compared achievement of the ACR/ EULAR Boolean remission during two years of follow-up. RESULTS We included 189 patients from ARCTIC and 330 patients from NOR-VEAC. More than half in each cohort had reached the study-specific target at 6 months, increasing to more than 60% at 12 and 24 months. The odds of reaching ACR/EULAR Boolean remission during follow-up were higher in ARCTIC than in NOR-VEAC, with statistically significant differences at 3 months (OR 1.73; 95% CI 1.03-2.89), 12 months (OR 1.97; 95% CI 1.21-3.20) and 24 months (OR 1.82; 95% CI 1.05 - 3.16). CONCLUSION A majority of patients in both cohorts reached the study-specific treatment targets. More patients in ARCTIC than in NOR-VEAC achieved ACR/EULAR Boolean remission during follow-up, suggesting that targeting a more stringent definition of remission provide further potential for favorable outcomes of a TTT strategy.
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Affiliation(s)
- Vibeke Norvang
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Siri Lillegraven
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Houchen Lyu
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen S Norli
- Department of Rheumatology, Martina Hansens Hospital, Sandvika, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women´s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Espen A Haavardsholm
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Rheumatology, Østfold Hospital, Grålum, Norway
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