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Ranganath VK, Maranian P, Elashoff DA, Woodworth T, Khanna D, Hahn T, Sarkisian C, Kremer JM, Furst DE, Paulus HE. Comorbidities are associated with poorer outcomes in community patients with rheumatoid arthritis. Rheumatology (Oxford) 2013; 52:1809-17. [PMID: 23813577 DOI: 10.1093/rheumatology/ket224] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To evaluate the impact of comorbidities on achieving remission by examining changes in the clinical disease activity index (CDAI) in RA patients in the community-based Consortium of Rheumatology Researchers of North America (CORRONA) registry. METHODS A subcohort of 1548 RA subjects with varying disease duration met the following inclusion criteria: started a DMARD/biologic agent, continued therapy ≥ 3 months, CDAI ≥ 2.8 at study entry and followed longitudinally from baseline to follow-up (mean time 7.46 months). Patients reported comorbidities according to a standardized list of 33 conditions. Entry characteristics were compared across age categories using one-way analysis of variance. Linear and logistic regression models were constructed to assess characteristics [e.g. age, disease duration, number of previous DMARDs/biologics, baseline modified health assessment questionnaire (MHAQ), baseline CDAI and number of comorbidities] associated with primary outcomes: change in CDAI (baseline to follow-up) and CDAI remission (yes/no). RESULTS Although disease activity measures at entry were similar across age categories, older patients had more comorbidities, less improvement in CDAI/MHAQ and were less likely to attain remission at follow-up. However, after adjusting covariates an increasing number of patient-reported comorbidities and higher baseline CDAI (but not age) were consistently and independently associated with a lower likelihood of clinical improvement or remission (P < 0.001). CONCLUSION In this observational cohort of community RA patients an increasing number of patients reported comorbidities, independently correlated with less CDAI improvement over time. These results reaffirm that comorbidities may be an important factor in consideration of treat-to-target recommendations and aid in understanding achievable RA therapeutic goals.
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Affiliation(s)
- Veena K Ranganath
- University of California at Los Angeles, 1000 Veteran Avenue, Rehab Building 32-59, Los Angeles, CA 90095, USA.
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Jawaheer D, Messing S, Reed G, Ranganath VK, Kremer JM, Louie JS, Khanna D, Greenberg JD, Furst DE. Significance of sex in achieving sustained remission in the consortium of rheumatology researchers of North America cohort of rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 2013; 64:1811-8. [PMID: 22730408 DOI: 10.1002/acr.21762] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 06/07/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine whether men with rheumatoid arthritis (RA) are more likely to achieve remission compared to women. METHODS RA patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) cohort between October 2001 and January 2010 were selected for the present analyses. Detailed clinical, demographic, and drug utilization data were available at enrollment (baseline) and at subsequent followup visits. We examined the influence of sex on the Clinical Disease Activity Index remission score (≤2.8) using sustained remission or point remission as the primary outcome measure in multivariate stepwise logistic regression models. We stratified the data by RA duration at baseline (≤2 years or >2 years) to investigate whether RA duration had differential effects on remission in men and women. RESULTS A total of 10,299 RA patients (2,406 men and 7,893 women) were available for this study. In both early and established RA, women had more severe disease at baseline with worse disease activity measures, modified Health Assessment Questionnaire disability index score, pain on a visual analog scale, and depression. Women were also more likely to have been treated with disease-modifying antirheumatic drugs and anti-tumor necrosis factor therapy compared to men. In the regression models, male sex was associated with sustained remission in early RA (odds ratio [OR] 1.38, 95% confidence interval [95% CI] 1.07-1.78, P = 0.01), but not in established RA. However, for point remission, an inverse association was observed with male sex in established RA (OR 0.65, 95% CI 0.48-0.87, P = 0.005) and not in early RA. CONCLUSION Within the large real-life CORRONA cohort of RA patients, men were more likely to achieve sustained remission compared to women in early RA, although not in established RA.
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Affiliation(s)
- Damini Jawaheer
- Children's Hospital Oakland Research Institute, Oakland, California, USA
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Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LHD, Funovits J, Aletaha D, Allaart CF, Bathon J, Bombardieri S, Brooks P, Brown A, Matucci-Cerinic M, Choi H, Combe B, de Wit M, Dougados M, Emery P, Furst D, Gomez-Reino J, Hawker G, Keystone E, Khanna D, Kirwan J, Kvien TK, Landewé R, Listing J, Michaud K, Martin-Mola E, Montie P, Pincus T, Richards P, Siegel JN, Simon LS, Sokka T, Strand V, Tugwell P, Tyndall A, van der Heijde D, Verstappen S, White B, Wolfe F, Zink A, Boers M. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. ACTA ACUST UNITED AC 2013; 63:573-86. [PMID: 21294106 DOI: 10.1002/art.30129] [Citation(s) in RCA: 554] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Remission in rheumatoid arthritis (RA) is an increasingly attainable goal, but there is no widely used definition of remission that is stringent but achievable and could be applied uniformly as an outcome measure in clinical trials. This work was undertaken to develop such a definition. METHODS A committee consisting of members of the American College of Rheumatology, the European League Against Rheumatism, and the Outcome Measures in Rheumatology Initiative met to guide the process and review prespecified analyses from RA clinical trials. The committee requested a stringent definition (little, if any, active disease) and decided to use core set measures including, as a minimum, joint counts and levels of an acute-phase reactant to define remission. Members were surveyed to select the level of each core set measure that would be consistent with remission. Candidate definitions of remission were tested, including those that constituted a number of individual measures of remission (Boolean approach) as well as definitions using disease activity indexes. To select a definition of remission, trial data were analyzed to examine the added contribution of patient-reported outcomes and the ability of candidate measures to predict later good radiographic and functional outcomes. RESULTS Survey results for the definition of remission suggested indexes at published thresholds and a count of core set measures, with each measure scored as 1 or less (e.g., tender and swollen joint counts, C-reactive protein [CRP] level, and global assessments on a 0-10 scale). Analyses suggested the need to include a patient-reported measure. Examination of 2-year followup data suggested that many candidate definitions performed comparably in terms of predicting later good radiographic and functional outcomes, although 28-joint Disease Activity Score-based measures of remission did not predict good radiographic outcomes as well as the other candidate definitions did. Given these and other considerations, we propose that a patient's RA can be defined as being in remission based on one of two definitions: (a) when scores on the tender joint count, swollen joint count, CRP (in mg/dl), and patient global assessment (0-10 scale) are all ≤ 1, or (b) when the score on the Simplified Disease Activity Index is ≤ 3.3. CONCLUSION We propose two new definitions of remission, both of which can be uniformly applied and widely used in RA clinical trials. We recommend that one of these be selected as an outcome measure in each trial and that the results on both be reported for each trial.
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Affiliation(s)
- David T Felson
- Boston University School of Medicine, Boston, Massachusetts, USA
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Pomirleanu C, Ancuta C, Miu S, Chirieac R. A predictive model for remission and low disease activity in patients with established rheumatoid arthritis receiving TNF blockers. Clin Rheumatol 2013; 32:665-70. [PMID: 23292520 DOI: 10.1007/s10067-012-2146-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 10/01/2012] [Accepted: 12/10/2012] [Indexed: 11/26/2022]
Abstract
The objective of this study was to identify predictors for remission or low disease activity (LDA) in established rheumatoid arthritis (RA) at 12 months of anti-TNF-α therapy. We have performed a prospective observational study in 90 consecutive patients with active RA receiving TNF-α inhibitors. Baseline and standard assessments were done every 3 months, including individual parameters (clinical and biological) and composite activity scores (28-joint disease activity score, DAS28). The primary outcome measure was DAS28-based EULAR response criteria. The multivariate logistic regression was used to analyze the association between disease activity and several RA baseline characteristics. Of the RA, 78.8 % was classified as good responders based on the EULAR-DAS28 criteria, 44.4 % RA achieving remission (DAS28 ≤ 2.6) and 34.4 %, LDA (DAS28 ≤ 3.2). Parameters associated with an increased likelihood of remission and LDA were initial DAS28-erythrocyte sedimentation rate ≤ 7 (odds ratio (OR) 3.3, 95 % confidence interval (CI) 2.03-5.81; OR 1.8, 95 % CI 1.09-6.68), Health Assessment Questionnaire Disability Index ≤ 2 (OR 7.0, 95 % CI 1.56-31.91; OR 1.3, 95 % CI 1.03-5.79), C-reactive protein level ≤ 20 mg/l (OR 1.5, 95 % CI 0.29-8.22; OR 0.5, 95 % CI0.08-2.97), rheumatoid factor ≤ 20 IU/ml (OR 18.9, 95 % CI 10.79-38.36; OR 32.9, 95 % CI 4.03-269), anti-cyclic citrullinated peptide antibodies ≤ 40 IU/ml (OR 3.5, 95 % CI 0.67-18.19; OR 1.2, 95 % CI 1.02-1.59), concurrent prednisolone (OR 0.2, 95 % CI 0.05-0.36; OR 0.2, 95 % CI 0.06-0.63), methotrexate or leflunomide (OR 1.6, 95 % CI 1.2-13.53; OR 2.9, 95 % CI 1.20-4.36). A predictive matrix for remission and LDA in established active RA patients receiving TNF-α inhibitors was proposed. Further studies are necessary to confirm the value of such matrix in particular RA settings, leading to optimization of the use of anti-TNF-α therapy.
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Davis JM, Matteson EL. My treatment approach to rheumatoid arthritis. Mayo Clin Proc 2012; 87:659-73. [PMID: 22766086 PMCID: PMC3538478 DOI: 10.1016/j.mayocp.2012.03.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/13/2012] [Accepted: 03/15/2012] [Indexed: 02/07/2023]
Abstract
The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival.
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Key Words
- acpa, anti–citrullinated protein antibody
- acr, american college of rheumatology
- best, behandel-strategieën [trial]
- cdai, clinical disease activity index
- crp, c-reactive protein
- ctla-4:ig, cytotoxic t lymphocyte–associated antigen 4:immunoglobulin fusion protein
- das28, disease activity score in 28 joints
- dmard, disease-modifying antirheumatic drug
- eular, european league against rheumatism
- hcq, hydroxychloroquine
- mtx, methotrexate
- sdai, simplified disease activity index
- ssz, sulfasalazine
- tear, treatment of early aggressive rheumatoid arthritis [study]
- tnf, tumor necrosis factor
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MESH Headings
- Abatacept
- Anti-Inflammatory Agents/pharmacology
- Anti-Inflammatory Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antirheumatic Agents/pharmacology
- Antirheumatic Agents/therapeutic use
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/pathology
- Arthritis, Rheumatoid/physiopathology
- Arthritis, Rheumatoid/therapy
- Biological Products/therapeutic use
- Comorbidity
- Diagnosis, Differential
- Drug Therapy, Combination
- Evidence-Based Medicine
- Humans
- Immunoconjugates/therapeutic use
- Isoxazoles/therapeutic use
- Joints/pathology
- Leflunomide
- Methotrexate/therapeutic use
- Prednisone/therapeutic use
- Prognosis
- Quality of Life
- Randomized Controlled Trials as Topic
- Referral and Consultation
- Remission Induction
- Rituximab
- Severity of Illness Index
- Sulfasalazine/therapeutic use
- Synovitis/etiology
- Time Factors
- Treatment Outcome
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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Affiliation(s)
- John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN 55905, USA.
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de Punder YMR, Fransen J, Kievit W, Houtman PM, Visser H, van de Laar MAFJ, van Riel PLCM. The prevalence of clinical remission in RA patients treated with anti-TNF: results from the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Rheumatology (Oxford) 2012; 51:1610-7. [PMID: 22539487 DOI: 10.1093/rheumatology/kes078] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To evaluate the prevalence of clinical remission and minimal disease activity according to the ACR/European League Against Rheumatism (EULAR) remission, DAS-28 <2.6 and minimal disease activity (MDA) criteria, and to compare the extent of residual disease activity with disability in RA patients after 6 months of treatment with anti-TNF. METHODS In the Dutch Rheumatoid Arthritis Monitoring (DREAM) biologic registry the prevalence of DAS-28 <2.6, MDA and ACR/EULAR remission criteria was assessed. Residual disease activity during MDA or remission was assessed as the percentage of patients with swollen and tender joints, elevated acute-phase reactants and general health on a visual analogue scale (VAS). Disability was evaluated with the HAQ score. RESULTS Prevalence of DAS-28 <2.6 was 27%, prevalence of MDA was 34% and ACR/EULAR remission was reached by 6% of patients. Residual disease activity was present mostly in the most lenient criteria and occurred most frequently on the level of swollen joint count and VAS score: at least one swollen joint in DAS-28 <2.6, MDA and ACR/EULAR remission was present in, respectively, 51, 54 and 34% of the patients. VAS >1 occurred in, respectively, 67, 69 and 0% of the patients. Modification of the cut-point of the patient-reported outcome increased the prevalence of ACR/EULAR remission, but also the level of disability. CONCLUSION MDA and DAS-28 <2.6 are reachable treatment targets in RA with anti-TNF, although residual disease activity might still be present. In turn, ACR/EULAR remission criteria leave little residual disease activity, but might be too stringent for use in daily clinical practice due to the strict cut-point in the patient-reported outcome.
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Affiliation(s)
- Yvonne M R de Punder
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Molecular serum and urine marker repertoire supporting clinical research on joint diseases. Best Pract Res Clin Rheumatol 2011; 25:859-72. [DOI: 10.1016/j.berh.2011.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/14/2011] [Indexed: 12/23/2022]
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Jawaheer D, Olsen J, Hetland ML. Sex differences in response to anti-tumor necrosis factor therapy in early and established rheumatoid arthritis -- results from the DANBIO registry. J Rheumatol 2011; 39:46-53. [PMID: 22089458 DOI: 10.3899/jrheum.110548] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To investigate sex differences in response to anti-tumor necrosis factor-α (TNF-α) therapy over time in early versus established rheumatoid arthritis (RA). METHODS Patients with RA who initiated anti-TNF therapy between January 2003 and June 2008 in Denmark were selected from the DANBIO Registry. Sex differences in baseline disease features were examined using chi-square, Mann-Whitney U tests, and t tests. Using a generalized estimating equations (GEE) model for repeated measures, we examined European League Against Rheumatism (EULAR) responses in men and women over 48 months of followup, adjusting for baseline values of age, 28-joint Disease Activity Score (DAS28), disease duration, and anti-TNF, methotrexate, and prednisolone use. RESULTS At initiation of anti-TNF therapy (baseline), 328 women and 148 men had early RA (≤ 2 yrs), and 1245 women and 408 men had established RA (> 2 yrs). In both early and established RA, men and women had active disease with similar DAS28 scores (mean ± SD 5.2 ± 1.1), physician global scores, swollen joint counts, and radiographic changes. In early RA, men were significantly more likely to achieve a EULAR good/moderate response over 48 months compared to women (GEE; p = 0.003), and a significant interaction between sex and followup time (GEE; p < 0.0005) suggested that men achieved this response sooner than women. CONCLUSION Better responses to anti-TNF therapy among men compared to women in early but not established RA suggest that disease duration at initiation of therapy may be an important factor to consider when investigating sex differences in treatment responses.
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Affiliation(s)
- Damini Jawaheer
- Children's Hospital Oakland Research Institute (CHORI), 5700 Martin Luther King Jr. Way, Oakland, CA 94609-1609, USA.
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¿Son útiles los factores pronóstico en la artritis reumatoide? ACTA ACUST UNITED AC 2011; 7:339-42. [DOI: 10.1016/j.reuma.2010.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 11/15/2010] [Accepted: 11/17/2010] [Indexed: 11/18/2022]
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Di Muzio G, Perricone C, Ballanti E, Kroegler B, Greco E, Novelli L, Conigliaro P, Cipriani P, Giacomelli R, Perricone R. Complement system and rheumatoid arthritis: relationships with autoantibodies, serological, clinical features, and anti-TNF treatment. Int J Immunopathol Pharmacol 2011; 24:357-66. [PMID: 21658310 DOI: 10.1177/039463201102400209] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autoantibodies (rheumatoid factor, RF; anti-citrullinated-protein antibodies, ACPA) and complement system are involved in rheumatoid arthritis (RA). ACPA and anti-TNF agents are capable of in vitro modulating complement activity. We investigated the relationships between complement, autoantibodies, and anti-TNF treatment in vivo. One-hundred fourteen RA patients (89F/25M), diagnosed according to 1987 ACR criteria, and 30 healthy controls were enrolled. Serological analysis included ESR, CRP, complement C3, C4 and CH50, RF and ACPA (ELISA, cut-off>20 U/ml). Split-products (SP) of C3 and B were studied by immunoelectrophoresis/counterimmunoelectrophoresis. Seventy-six patients started anti-TNF treatment and were studied at baseline and after 22 weeks. Disease activity was measured with DAS28 and response to therapy with EULAR criteria. At baseline, RA patients showed significantly higher levels of C3 and C4 than controls (C3 127.9±26.5 vs 110±25 mg/dl, P=0.0012; C4 29.7±10.2 vs 22.7±8.3mg/dl, P=0.0003). No differences in C3, C4 and CH50 levels were observed between ACPA+ (n=76) and ACPA- (n=38) patients. After 22 weeks of anti-TNF, C3, C4 and RF were significantly reduced (P<0.003, <0.005 and <0.04, respectively) and RF changes showed negative correlation with CH50. SP of C3 and B were observed neither at baseline nor after 22 weeks. DAS28 significantly improved after 22 weeks. Patients showing higher baseline C3 or lower reduction of C3 levels after 22 weeks had a worse EULAR outcome (X2=22.793, P<0.001). RF levels seem to correlate with complement CH50. The presence of high levels of C3 in RA patients may reflect a pro-inflammatory status and represent a negative prognostic factor for anti-TNF therapy.
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Affiliation(s)
- G Di Muzio
- Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
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Impact of patient and disease characteristics on therapeutic success during adalimumab treatment of patients with rheumatoid arthritis: data from a German noninterventional observational study. Rheumatol Int 2011; 32:2759-67. [PMID: 21822659 PMCID: PMC3429775 DOI: 10.1007/s00296-011-2033-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/10/2011] [Indexed: 12/19/2022]
Abstract
The objective of this study was to use data from a noninterventional study to evaluate the effectiveness of adalimumab in rheumatoid arthritis (RA) patients during routine clinical practice and to explore the potential impact of patient and disease characteristics in response to adalimumab therapy. A total of 2,625 RA patients with specified data at baseline (prior to initiating adalimumab treatment) and 12 months entered this study between April 2003 and March 2009. We evaluated response to adalimumab therapy and conducted stepwise regression and subgroup analyses of factors influencing therapeutic response. During the 1-year adalimumab treatment period, disease activity decreased from a baseline mean disease activity score-28 joints (DAS28) of 5.9-3.9, while functional capacity improved from 59.0 to 68.4 Funktionsfragebogen Hannover (FFbH) percentage points. In multivariate regression models, high baseline DAS28 was the strongest positive predictor for decrease in disease activity, and high baseline functional capacity was associated with reduced gains in functional capacity. Male gender was a positive predictor of therapeutic response for both disease activity and functional capacity, while older age and multiple previous biologics were associated with a reduced therapeutic response. Subset analyses provided further support for the impact of baseline DAS28, FFbH, and prior biologic therapy on therapeutic response during treatment. We conclude that treatment with adalimumab leads to decreased disease activity and improved function during routine clinical practice. Patients with high disease activity and low functional capacity are particularly benefitted by adalimumab therapy.
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Furst DE, Pangan AL, Harrold LR, Chang H, Reed G, Kremer JM, Greenberg JD. Greater likelihood of remission in rheumatoid arthritis patients treated earlier in the disease course: results from the Consortium of Rheumatology Researchers of North America registry. Arthritis Care Res (Hoboken) 2011; 63:856-64. [PMID: 21337725 DOI: 10.1002/acr.20452] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine whether disease duration is an independent predictor of achieving remission in rheumatoid arthritis (RA) patients initiating therapy. METHODS RA patients in the Consortium of Rheumatology Researchers of North America registry newly prescribed a nonbiologic disease-modifying antirheumatic drug (DMARD) or anti--tumor necrosis factor (anti-TNF) with at least one followup visit were identified. Achievement of remission was defined using the Clinical Disease Activity Index (CDAI; score ≤2.8) and 28-joint Disease Activity Score (DAS28; score <2.6) at any followup visit within one year; sustained remission was defined as remission during any two successive visits. Likelihood of remission was examined through logistic regression based on 5-year increments of disease duration, adjusting for baseline covariates. RESULTS Among the 1,646 nonbiologic DMARD initiators, CDAI remission occurred in 21.3% of those with ≤5 years of disease duration, 19.6% with 6-10 years, and 13.5% with ≥11 years (P < 0.001); sustained remission occurred in 10.2%, 8.8%, and 2.5%, respectively (P < 0.001). Results were similar among the 3,179 anti-TNF initiators (CDAI remission in 22.3%, 17.7%, and 12.8%, respectively [P < 0.001]; CDAI sustained remission in 9.7%, 9.5%, and 4.2%, respectively [P < 0.001]). DAS28 results were similar in both groups. In adjusted analyses, an increase of disease duration by 5 years was associated with a reduced likelihood of CDAI remission in nonbiologic DMARD (odds ratio [OR] 0.91, 95% confidence interval [95% CI] 0.83-0.99) and anti-TNF initiators (OR 0.88, 95% CI 0.83-0.94). A similar result was seen for sustained remission using the CDAI (nonbiologic DMARD: OR 0.61, 95% CI 0.48-0.76; anti-TNF: OR 0.85, 95% CI 0.75-0.97). CONCLUSION Earlier treatment was associated with a greater likelihood of remission.
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Affiliation(s)
- Daniel E Furst
- Geffen School of Medicine, University of California, Los Angeles, USA
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Poddubnyy D, Rudwaleit M. Efficacy and safety of adalimumab treatment in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Expert Opin Drug Saf 2011; 10:655-73. [PMID: 21554150 DOI: 10.1517/14740338.2011.581661] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In the last couple of years, the number of patients with chronic inflammatory rheumatic diseases being treated with TNF α antagonist has increased dramatically. Adalimumab, a fully human monoclonal antibody against TNF α, is one of the most frequently administered TNF α antagonists. Yet, unresolved issues are the long-term safety of TNF α antagonists and high treatment costs. AREAS COVERED The authors summarize the available data on short- and long-term efficacy and safety of adalimumab in the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. The reader will find a comprehensive overview on the safety and efficacy of adalimumab for these conditions. Clinically relevant questions of adalimumab therapy are discussed. A special focus of this review is on the safety of adalimumab therapy. EXPERT OPINION Adalimumab is effective and reasonably safe in the short- and long-term treatment of patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who do not respond to the standard therapy. It inhibits radiographic progression in rheumatoid and psoriatic arthritis. Treatment with a TNF α inhibitor such as adalimumab is associated with high treatment costs.
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Affiliation(s)
- Denis Poddubnyy
- Charite - Campus Benjamin Franklin, Department of Rheumatology , Hindenburgdamm 30, 12203 Berlin , Germany
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Deighton C, Hyrich K, Ding T, Ledingham J, Lunt M, Luqmani R, Kiely P, Bukhari M, Abernethy R, Ostor A, Bosworth A, Gadsby K, McKenna F, Finney D, Dixey J. BSR and BHPR rheumatoid arthritis guidelines on eligibility criteria for the first biological therapy. Rheumatology (Oxford) 2010:keq006b. [PMID: 20308120 DOI: 10.1093/rheumatology/keq006b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Affiliation(s)
- Chris Deighton
- Rheumatology Department, Royal Derby Hospital, Derby, ARC Epidemiology Unit, University of Manchester, Manchester, Rheumatology Unit, Queen Alexandra Hospital, Portsmouth, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Rheumatology Department, St George's Healthcare, London, Rheumatology Department, Royal Lancaster Infirmary, Lancaster, Rheumatology Department, St Helens Hospital, St Helens, Rheumatology Department, Addenbrooke's Hospital, Cambridge, National Rheumatoid Arthritis Society, Maidenhead, Department of Rheumatology, Trafford General Hospital, Manchester, Rheumatology Unit, Worthing and Southlands NHS Trust, Worthing and Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Katchamart W, Johnson S, Lin HJL, Phumethum V, Salliot C, Bombardier C. Predictors for remission in rheumatoid arthritis patients: A systematic review. Arthritis Care Res (Hoboken) 2010; 62:1128-43. [DOI: 10.1002/acr.20188] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Le Loët X, Kozyreff Meurice M, Lequerré T, Vittecoq O. Polyarthrite rhumatoïde : définitions de la réponse, des différents niveaux d’activité et de la rémission. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.monrhu.2009.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rintelen B, Sautner J, Haindl PM, Andel I, Maktari A, Leeb BF. Comparison of three rheumatoid arthritis disease activity scores in clinical routine. Scand J Rheumatol 2009; 38:336-41. [DOI: 10.1080/03009740902932835] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Hyrich KL, Deighton C, Watson KD, Symmons DPM, Lunt M. Benefit of anti-TNF therapy in rheumatoid arthritis patients with moderate disease activity. Rheumatology (Oxford) 2009; 48:1323-7. [PMID: 19706737 PMCID: PMC2744336 DOI: 10.1093/rheumatology/kep242] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives. Anti-TNF therapy has improved outcomes for patients with highly active RA. Less is known about its effectiveness in patients with lower disease activity. The aim of this analysis is to compare the response to anti-TNF therapy between RA patients with high (DAS28 > 5.1) and moderate (DAS28 > 3.2–5.1) disease activity. Methods. A total of 4687 anti-TNF and 344 DMARD patients with high disease activity despite treatment with two standard DMARDs (including MTX) and 224 anti-TNF- and 300 DMARD-treated patients with moderate disease activity were selected from the British Society For Rheumatology Biologics Register. Mean change in HAQ over the first 12 months of enrolment was compared first between anti-TNF-treated and untreated patients in each DAS28 group, and then between anti-TNF-treated patients in the moderate and high DAS28 groups, using doubly robust estimates, adjusting for age, gender, disease duration, baseline HAQ and DAS28 score, number of previous DMARDs and steroid use. Results. Compared with anti-TNF-untreated patients within each DAS group, treated patients were younger, had higher DAS28 and HAQ and had failed a higher number of previous DMARDs. The mean adjusted change in HAQ over 12 months was similar in anti-TNF-treated patients with moderate and high disease activity at baseline: moderate −0.26 (95% CI −0.35, −0.16), high −0.28 (95% CI −0.34, −0.23) and mean difference −0.03 (95% CI −0.14, 0.08). Conclusions. Improvement in HAQ score 12 months after start of anti-TNF therapy was not dependent on baseline DAS28 scores, suggesting that substantial benefits may also be gained by treating those with moderately active disease despite standard DMARD therapy.
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Affiliation(s)
- Kimme L Hyrich
- ARC Epidemiology Unit, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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van der Woude D, Young A, Jayakumar K, Mertens BJ, Toes REM, van der Heijde D, Huizinga TWJ, van der Helm-van Mil AHM. Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: Results from two large early arthritis cohorts. ACTA ACUST UNITED AC 2009; 60:2262-71. [DOI: 10.1002/art.24661] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Russo RAG, Katsicas MM. Clinical remission in patients with systemic juvenile idiopathic arthritis treated with anti-tumor necrosis factor agents. J Rheumatol 2009; 36:1078-82. [PMID: 19435972 DOI: 10.3899/jrheum.090952] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the frequency of clinical remission in a cohort of patients with systemic juvenile idiopathic arthritis (JIA) who received continuous anti-tumor necrosis factor (TNF) therapy; and to identify potential predictors of remission. METHODS Patients with systemic JIA who were treated with anti-TNF agents for > 6 months were studied. Demographic and nosologic variables recorded at the start of anti-TNF therapy were analyzed. Association between early variables and occurrence of remission was evaluated through Cox proportional hazard regression analysis. RESULTS Forty-five patients were included (30 girls), median age 9 years (range 2-17 yrs), age at disease onset 5 years (range 0.5-15), disease duration 3 years (range 0.5-13). Twenty-one (47%) children showed systemic symptoms at the start of anti-TNF therapy. Patients received therapy for 24 months (range 6-88): 45 (100%) were given etanercept, 17 (38%) infliximab, and 5 (11%) adalimumab, in combination with methotrexate. Anti-TNF switching was performed in 22 (49%) children. Eleven (24%) met definition criteria for remission while taking etanercept (n = 8), infliximab (2), or adalimumab (1). Remission occurred following 26 (range 9-65) months of therapy. Flares occurred in 5 (45%) patients 2 to 14 months after remission was first recorded. Absence of systemic symptoms at the start of therapy and fulfillment of improvement criteria at Month 3 were associated with remission in univariate analysis; no variable showed any association in multivariate analysis. CONCLUSION Twenty-four percent of patients with systemic JIA experienced remission with anti-TNF therapy, but only 13% experienced sustained benefit.
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Affiliation(s)
- Ricardo A G Russo
- Servicio de Inmunología y Reumatología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Pichincha, Buenos Aires, Argentina.
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Deighton C, Hyrich K. Why do the French get much greater access to anti-TNF than the British? Vive la difference? Pas necessairement. Rheumatology (Oxford) 2008; 47:1600-2. [DOI: 10.1093/rheumatology/ken353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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