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McGagh D, Song K, Yuan H, Creagh AP, Fenton S, Ng WF, Goldsack JC, Dixon WG, Doherty A, Coates LC. Digital health technologies to strengthen patient-centred outcome assessment in clinical trials in inflammatory arthritis. THE LANCET. RHEUMATOLOGY 2024:S2665-9913(24)00186-3. [PMID: 39089297 DOI: 10.1016/s2665-9913(24)00186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/22/2024] [Accepted: 06/18/2024] [Indexed: 08/03/2024]
Abstract
Common to all inflammatory arthritides, namely rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and juvenile idiopathic arthritis, is a potential for reduced mobility that manifests through joint pain, swelling, stiffness, and ultimately joint damage. Across these conditions, consensus has been reached on the need to capture outcomes related to mobility, such as functional capacity and physical activity, as core domains in randomised controlled trials. Existing endpoints within these core domains rely wholly on self-reported questionnaires that capture patients' perceptions of their symptoms and activities. These questionnaires are subjective, inherently vulnerable to recall bias, and do not capture the granularity of fluctuations over time. Several early adopters have integrated sensor-based digital health technology (DHT)-derived endpoints to measure physical function and activity in randomised controlled trials for conditions including Parkinson's disease, Duchenne's muscular dystrophy, chronic obstructive pulmonary disease, and heart failure. Despite these applications, there have been no sensor-based DHT-derived endpoints in clinical trials recruiting patients with inflammatory arthritis. Borrowing from case studies across medicine, we outline the opportunities and challenges in developing novel sensor-based DHT-derived endpoints that capture the symptoms and disease manifestations most relevant to patients with inflammatory arthritis.
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Affiliation(s)
- Dylan McGagh
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Kaiyang Song
- Oxford Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Hang Yuan
- Big Data Institute, University of Oxford, Oxford, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew P Creagh
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Sally Fenton
- School of Sport, Exercise, and Rehabilitation Science, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Wan-Fai Ng
- Health Research Board Clinical Research Facility, University College Cork, Cork, Ireland; Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK; NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Salford, UK
| | - Aiden Doherty
- Big Data Institute, University of Oxford, Oxford, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Gollins CE, Vincent R, Fahy C, McHugh N, Brooke M, Tillett W. Effectiveness of sequential lines of biologic and targeted small-molecule drugs in psoriatic arthritis: a systematic review. Rheumatology (Oxford) 2024; 63:1790-1802. [PMID: 38243715 DOI: 10.1093/rheumatology/keae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To assess current evidence for effectiveness of sequential lines of biologic and targeted small-molecule disease-modifying anti-rheumatic drugs (b/tsDMARDs) when used beyond first-line for psoriatic arthritis (PsA). METHODS A systematic search of the literature (Medline, Embase, bibliographic searches) was undertaken (October and December 2022) to find studies meeting the criteria of assessing effectiveness of b/tsDMARDs beyond first-line in adults with PsA (PROSPERO CRD42022365298). Risk of bias assessment was undertaken (ROBINS-I/Cochrane RoB2). RESULTS Of 2666 abstracts identified and following a full text review of 177 psoriatic disease studies, 12 manuscripts and two abstracts were eligible. Of the 12 manuscripts, 11 were observational and one was a sub-analysis of a RCT (n = 16 081: average age 49.5 years, female 53.3%). Two abstracts (n = 7186) were included. All studies comparing first- and second-line (three studies) found a reduced response in second-line. On average, DAPSA remission (most reported outcome, eight studies) was achieved in 26%, 19% and 10% first-, second- and third-line TNFi, and 22%, 13% and 11% first-, second- and third-line other bDMARDs, respectively. Responses varied to third-line bDMARDs; four studies found comparable second- and third-line responses, five studies found diminishing responses in sequential lines. CONCLUSION Predominantly observational studies, inherently at high risk of bias, indicate bDMARDs can be effective to third-line in PsA, but that response is reduced after first line. There is very limited data for more advanced lines of b/tsDMARD. Prospective studies are required to better understand clinical response to advanced lines of treatment in PsA.
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Affiliation(s)
- Charlotte E Gollins
- Department of Dermatology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Rosie Vincent
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Caoimhe Fahy
- Department of Dermatology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Neil McHugh
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Mel Brooke
- British Psoriatic Arthritis Consortium (BritPACT), Bath Institute for Rheumatic Diseases, Royal United Hospital, Bath, UK
| | - William Tillett
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath, UK
- Royal National Hospital for Rheumatic Diseases, Bath, UK
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Ziadé N, Abbas N, Hmamouchi I, El Kibbi L, Maroof A, Elzorkany B, Abdulateef N, Adnan A, Ihsan Awadh N, Gorial FI, Alchama N, Haouichat C, Alnaimat F, Hannawi S, Atawnah S, Halabi H, Al Mashaleh M, Aljazwi L, Abogamal A, Ayoub L, Bouajina E, Bahiri R, Saad S, Sabkar M, Aouad K, Gossec L. Is the patient-perceived impact of psoriatic arthritis a global concept? An international study in 13 Arab countries (TACTIC study). Rheumatol Int 2024; 44:885-899. [PMID: 38498150 DOI: 10.1007/s00296-024-05552-1] [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: 12/25/2023] [Accepted: 01/27/2024] [Indexed: 03/20/2024]
Abstract
The Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire, a recommended measure of patient-reported impact for psoriatic arthritis (PsA), was initially developed in Europe and may lack universal validity. Recognizing the need for a culturally appropriate tool for Arab patients, this study aimed to TranslAte, CulTurally adapt, and validate the PsAID in ArabIC (TACTIC). The PsAID-12 was translated into Arabic using a rigorous process of double translation, back-translation, and cognitive debriefing. The Arabic version was then validated through a study conducted in 13 Arab countries in 2022. Participants were consecutive literate adult patients diagnosed with PsA and fulfilling the CASPAR criteria. Collected data included PsAID-12, disease activity, and legacy patient-reported outcomes. Psychometric properties, such as internal consistency, construct validity, and test-retest reliability, were examined. Factors associated with high PsAID-12 total scores (> 4) were explored using multivariable binary logistic regression. A culturally adapted Arabic PsAID-12 questionnaire was achieved with minor rephrasing. The validation study included 554 patients from 13 countries (mean age 45 years, 59% females), with a mean PsAID score of 3.86 (SD 2.33). The Arabic PsAID-12 demonstrated excellent internal consistency (Cronbach's α = 0.95), and correlations with other measures ranged from 0.63 to 0.78. Test-retest reliability (N = 138 patients) was substantial (intraclass correlation coefficient, ICC 0.90 [0.86-0.93]; Cohen's kappa 0.80). Factors associated with a high PsAID score were disability (odds ratio, OR 3.15 [2.03-4.89]), depression (OR 1.56 [1.35-1.81]), widespread pain (OR 1.31 [1.12-1.53]), and disease activity (OR 1.29 [1.13-1.47]). Pain and fatigue were identified as the most impactful PsAID-12 domains for PsA patients. The Arabic PsAID is a valid and reliable measure that reflects the priorities of patients with PsA. PsAID scores correlated with disease activity and legacy outcome measures, as expected, indicating PsAID is a consistent measure of PsA impact across cultures. These findings highlight the potential of the Arabic PsAID in improving the care provided to Arabic-speaking patients worldwide.
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Affiliation(s)
- Nelly Ziadé
- Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Noura Abbas
- Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ihsane Hmamouchi
- Laboratory of Clinical Research and Epidemiology, Faculty of Medicine, Mohammed V University, Rabat, Morocco
- Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Centre, Riyadh, Saudi Arabia
| | - Avin Maroof
- University of Kurdistan-Hewler (UKH) School of Medicine; and Rizgary Hospital Erbil, Erbil, Iraq
| | | | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Asal Adnan
- Baghdad Teaching Hospital, Baghdad Medical City, Baghdad, Iraq
| | | | - Faiq Isho Gorial
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Nada Alchama
- Rheumatology Department, Ibn Al-Nafees Hospital, Damascus, Syria
| | - Chafika Haouichat
- Rheumatology Department, Djilali Bounaama University Hospital, Khemis Miliana, Douera, Algiers, Algeria
- Faculty of Medicine El Mahdi Si Ahmed., Blida, Algeria
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Medicine, The University of Jordan, Amman, Jordan
| | - Suad Hannawi
- Rheumatology Department, Emirates Health Services, Ministry of Health and Prevention, Dubai, UAE
| | - Saed Atawnah
- Al-Ahli Hospital, Al-Quds University, Hebron, Palestine
| | - Hussein Halabi
- Section of Rheumatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Manal Al Mashaleh
- Rheumatology Division of Internal Medicine, King Hussein Medical Centre, Royal Medical Services, Jordan Armed Forces, Amman, Jordan
| | | | - Ahmed Abogamal
- Al-Azhar Faculty of Medicine, Dr Sulaiman Al Habib Hospital, Dubai, UAE
| | - Laila Ayoub
- Rheumatology Unit, Department of Internal Medicine, Tripoli Central Hospital, Tripoli, Libya
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Rachid Bahiri
- El Ayachi Hospital, Medical University Hospital, Rabat, Morocco
| | - Sahar Saad
- Assiut Medical School of Egypt, King Hamad University Hospital Bahrain, Al Sayh, Bahrain
| | - Maha Sabkar
- King Hamad University Hospital, Al Sayh, Bahrain
| | - Krystel Aouad
- Saint George Hospital University Medical Centre, Saint George University of Beirut, Beirut, Lebanon
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
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Gollins CE, Tillett W. Ustekinumab with or without methotrexate for psoriatic arthritis? THE LANCET. RHEUMATOLOGY 2023; 5:e2-e3. [PMID: 38251505 DOI: 10.1016/s2665-9913(22)00359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Charlotte E Gollins
- Royal National Hospital for Rheumatic Diseases, Rheumatology Department, Bath, UK; Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath BA2 7AY, UK
| | - William Tillett
- Royal National Hospital for Rheumatic Diseases, Rheumatology Department, Bath, UK; Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath BA2 7AY, UK.
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