Increased remission with fewer corticosteroids and more biologics in rheumatoid arthritis at 7-year follow-up in real-life conditions

On-treatment clinical remission of severe asthma with real-world longer-term biologic use

Background

There are limited real-world data describing the proportion of patients with severe asthma (SA) who achieve on-treatment clinical remission with long-term biologic treatment.

Objective

Our aim was to examine the proportion and characteristics of adults with SA who achieved clinical remission with biologic therapy.

Methods

CHRONICLE is an observational study of US subspecialist-treated adults with SA. Sites reported exacerbations and biologic use from 12 months before enrollment forward. Monthly Asthma Control Test scores and 6-monthly specialist assessments of asthma control were collected. Patients who enrolled from February 2018 to February 2023, began taking a biologic during the study observation period, and continued use of that biologic for at least 12 months were evaluated. Incident on-treatment clinical remission was defined in a 12-month interval as the absence of exacerbations and systemic corticosteroid use, a 50% or greater improvement in Asthma Control Test scores of least 20 points in the latest 6 months, and specialist report of asthma control.

Results

Among the evaluable patients (n = 611), the median duration of biologic use was 39.6 months. In at least one 12-month interval during the study, 79.9% of patients had no exacerbations or systemic corticosteroid use and 46.0% met the definition of clinical remission at any point. The point prevalence of clinical remission increased from 22.3% at 12 to 13 months of biologic use to 34.3% at 47 to 48 months of biologic use.

Conclusions

In a real-world cohort of patients with SA with longer-term biologic treatment, almost one-half achieved on-treatment clinical remission. With at least 1 year of biologic therapy, clinical remission is a feasible treatment goal in SA.

Influencers of Achievement of Remission and Low Disease Activity in Response to Disease-Modifying Antirheumatic Drugs (DMARDs) in Patients With Rheumatoid Arthritis

BACKGROUND

In this prospective cohort study the objective was to identify the socio-demographic and clinical factors that influence treatment response to disease-modifying antirheumatic drugs (DMARDs) at ambulatory multicenter rheumatology outpatient clinics. The subjects were patients with rheumatoid arthritis satisfying the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria with informed consent.

MATERIALS AND METHODS

Pre-coded data sheets were used to capture socio-demographic and clinical characteristics. Baseline data was collected at time of patient recruitment. Only patients who had complete data at three-month follow-up were included in the study analysis. The study's outcome was achievement of remission or low disease activity. The study used the adherence in chronic disease scale and European Task Force for Patient Evaluation of General Practice tools to evaluate patient adherence and assessments of health care received. Data analysis was carried out using Prism 7 and SPSS. Categorical data were regulated as percentages, while continuous data were regulated as means and standard deviation. Prevalence (at 95% CIs) of various socio-demographic and clinical characteristics were calculated comparisons of socio-demographic characteristics, clinical characteristics between patients into achieved primary/secondary outcomes and those who didn't were carried out using the chi-square statistic (for categorical variables) and independent student T-test (for continuous variables). Logistic regression was performed to estimate the impact of moderator variables on study outcomes and to calculate adjusted odds ratio (OR) with corresponding 95% CI. Throughout analysis α < 0.05 was considered statistically significant.

RESULTS

A total of 206 patients were included. The mean age was 51.2 ± 15.1 years; mostly females (n=188 patients, 91.3%). Majority had attained post-primary education (n=172 patients, 83.5%). Only 74 patients (35.9%) had formal professional employment, while only six patients (3%) paid for healthcare via government-funded/private insurance. At recruitment, nearly half of the included patients had moderate to severe disability. Majority of patients had elevated baseline erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Most of the patients (90.3%) had a positive rheumatoid factor test at recruitment, while 58% had a positive anti-cyclic citrullinated peptide test. Majority had moderate disease activity. Thirty-three patients were in remission, 9.7% had low disease activity while 12.6% had high disease activity. Majority of patients (94.2%) were on non-steroidal anti-inflammatory drugs, non-biological DMARDs (80.6%) and systemic corticosteroids (54.9%). Mean duration of follow-up was 4.6 months. At follow-up, 37.9% found the system to be acceptable, 63.6% found the system to be problematic. Majority of the patients reported to have been adherent to therapy (high adherence: 7.8%; moderate adherence: 86.9%). The proportion of patients who achieved remission or low disease activity increased significantly at three-month follow-up.

CONCLUSION

 Having shorter disease duration, lower unemployment rates, higher income, lower non-adherence rates, having a positive outlook towards the healthcare system, normal CRP baseline, normal ESR baseline, and lower baseline of functional disability were significantly associated with increased chances of low disease activity/remission.

Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study

OBJECTIVES

The aim of the present study was to provide real-world evidence for factors predicting long-term remission in a longitudinal study of rheumatoid arthritis (RA) patients.

METHODS

Long-term remission was defined by meeting American Rheumatism Association (ARA) criteria for remission and prednisolone dose ≤ 5 mg/d for at least 5 years. Patients in this cohort were treated by tight control strategy using step-up combination therapy with conventional synthetic DMARDs (csDMARDs), biologic DMARDs. The parameters associated with long-term remission were subjected to univariate analysis, and parameters with P-values of < 0.1 in univariate analysis were included in a multivariate regression analysis.

RESULTS

One thousand two hundred and eighty-six RA subjects were considered for eligibility, and finally, 499 patients were included in the study. Median duration of follow-up was 108 months. Long-term remission occurred in 157 (31.5%) patients. Median time to long-term remission was 8 (5, 41) months. Predictors of long-term remission were absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being anti-citrullinated protein antibodies (ACPA) negative, and Disease Activity Score-28 (DAS28) at cohort entry ≤ 5.1.

CONCLUSION

In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset > 60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission. Key Points • In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. • Median time to long-term remission was 8 months. • Absence of flare during the course of disease, occurrence of sustained remission during 6 months after starting therapy, age at the disease onset >60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.

Long-term outcomes in Rheumatoid Arthritis: Review of data from the ‘Basildon Inflammatory Arthritis Cohort’

Objective

The aim was to determine outcomes in RA with long-term analysis of a real-world inception cohort.

Methods

We carried out a retrospective cohort analysis of 184 patients with a new diagnosis of RA (ACR/EULAR 2010 criteria) between 2009 and 2013. Measured parameters included patient demographics, serological markers, disease activity (DAS28-CRP), treatment regimen, development of new co-morbidities and all-cause mortality.

Results

Complete data were available for analysis in 171 patients, 60 men and 111 women, with a median age of 57 years and median follow-up time of 7.5 years. DAS-28 remission was achieved in 73%, with the majority continuing to require pharmacological therapy. Drug-free remission was achieved in 11.7%, whereas 3.5% remained refractory to treatment. Analysis of new co-morbidities revealed malignancy in 12.9% (n = 22), with lung cancer having the highest incidence (n = 9). Cardiovascular, pulmonary and cerebrovascular disease developed in 11.1% (n = 19), 5.8% (n = 10) and 5.3% (n = 9), respectively. The crude mortality rate was 19.3% (33 of 171), incidence mortality rate 174 per 10 000 person-years of follow-up and standardized mortality ratio 1.57 (95% CI 1.10, 2.17). More deaths were recorded from underlying malignancy [7.6% (n = 13)] than with cardiovascular disease [4.7% (n = 8)]. The majority of deaths occurred ≥5 years after initial diagnosis (67%).

Conclusion

Long-term analysis reveals that mortality in RA remains significantly elevated compared with the general population. Additionally, this real-world study underlines malignancy as the predominant cause of morbidity and mortality in RA.