Efficacy and safety of a mobile app intervention in patients with inflammatory arthritis: a prospective pilot study

EULAR highlighted the essential role of digital health in increasing self-management and improving clinical outcomes in patients with arthritis. The objective of this study was to evaluate the efficacy and safety of the digital health application (DHA) in patients with inflammatory arthritis. We assessed demographic parameters, treatment regimen, disease activity, and other patient-reported outcomes at baseline and after 4 weeks of DHA use added to standard care treatment. Of 17 patients, who completed the study, 7 (41.2%) patients were male, ranging from 19 to 63 (40.5 ± 12.2) years. No significant change in antirheumatic treatment was observed during the study. Statistically significant improvements (p < 0.05) were noted for health-related quality of life (increase in Physical Component Summary of Short Form-36 (SF-36) by 23.6%) and disease activity (decrease of Clinical Disease Activity Index and Simple Disease Activity Index by 38.4% and 39.9%, respectively). Clinically significant improvement was demonstrated for SF-36 Total Score (+ 14.4%), disease activity (Rheumatoid Arthritis Disease Activity Index− 5 to 15.9%), and depression (Patient Health Questionnaire− 9 to 13.5%). None of the efficacy parameters showed negative trends. No adverse events were reported throughout the study. The usability level was high i.e., the mean mHealth Application Usability Questionnaire Score of 5.96 (max.: 7.0) demonstrated a high level of application usability. This suggests that using a personalized disease management program based on DHA significantly improves several measures of patient-reported outcomes and disease activity in patients with inflammatory arthritis in a timely manner. These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.

AB1390 COMPLEMENTARY DIGITAL THERAPY SAFELY IMPROVES QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY ARTHRITIS

Background

Self-management strategies play a central role in improving clinical outcomes in patients with inflammatory arthritis. EULAR recently highlighted the essential role of digital health to increase the self-management of patients. Evidence regarding these supporting digital tools, including mobile apps, is currently however very limited [1].

Objectives

To evaluate the efficacy and safety of a mobile app (Mida Rheuma App) in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA, including psoriatic arthritis [PsA]) in a prospective study.

Methods

Patients with RA, SpA/ PsA, stable on their antirheumatic therapy for ≥4 weeks, were eligible to use the Mida Rheuma App in addition to standard care treatment. The usage of the app targeted the optimization of non-medical treatment in a 4-step process: (1) collection of the information (HRQoL, disease activity, physical impairment, diet, mental health, physical activity, etc.) using standardized questionnaires via the conversational health coach Mida; (2) development of a patient profile that focuses on the patient’s disease, well-being, and behavior; (3) creation of a personalized, evidence-based disease management program based on recommendations from medical guidelines, medical standards, and state-of-the-art clinical research; (4) implementation of personalized recommendations into the patient’s daily life by providing short daily tasks that accelerate positive behavior change. Additionally, the health coach Mida supports the patient in coping with stress, sadness, depression, fatigue, and further disease-related symptoms. This is achieved by various cognitive behavioral techniques, meditation and relaxation methods.

Additionally, we assessed demographic parameters, treatment regimen, disease activity (e.g., SDAI, ASDAS), and other patient-reported outcomes (e.g., SF-36) at baseline and after 4 weeks. The study was approved by the Ethics Committee of the Medical Faculty of Mannheim, Heidelberg University.

Results

Of 20 patients screened after obtaining informed consent, 19 were enrolled in the study, and 17 patients (12 RA, SpA: 1 axSpA, 4 PsA) completed the study (2 drop-outs due to unwillingness to finish the study). 7 (41.2%) patients were male, and ages ranged from 19 to 63 (40.5±12.2) years). Patients were treated as follows: 7 NSAIDs (41.2%), 2 GC (>5 mg) (11.8%), 3 HCQ (17.6%), 10 MTX (58.8%), 1 LEF (5.9%), 1 SSZ (5.9%), 1 APR (5.9%), 3 JAKi (17.6%), 1 TNFi (5.9%), 2 IL-6i (11.8%), 1 IL-17i (5.9%). No significant change in antirheumatic treatment was observed during the study. At baseline, 29.4% of the RA and PsA patients were in remission, 25.2% had low, 29.4% had moderate, and none had high disease activity according to SDAI, one axSpA patient had low disease activity (ASDAS: 2.2). At the end of the study, slightly more RA and PsA patients were in remission and had low disease activity (58.8% and 23.5%, respectively) and less had moderate activity (11.8%); the axSpA patient had inactive disease (ASDAS: 1.8).

Regarding patient-reported outcomes, statistically significant improvement was noted for the following parameters: SF-36 Total Score (relation of CI 90% and minimum clinically important difference of 2.5), increase of Physical Component Summary of SF-36 by 23.6% (p=0.024), ‘role limitations due to physical health’ by 76.9% (p=0.022), and ‘general health’ - by 17.1% (p=0.048); and evidence of potential clinical importance of their dynamics for Patient Health Questionnaire (PHQ)-9, ‘emotional well-being’ and RADAI-5. No negative changes were observed for assessed parameters. No adverse events were reported throughout the study.

Conclusion

This prospective study suggests that using an app-based personalized disease management program significantly quickly improves several measures of patient-reported outcomes and disease activity in patients with RA and PsA/SpA. These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.

References

[1]Knitza J. JMIR Mhealth Uhealth. 2019 Aug 5;7(8):e14991

Disclosure of Interests

Dmytro Fedkov Shareholder of: Midaia GmbH, Speakers bureau: Phizer, MSD, Consultant of: Janssen, Novartis, Andrea Berghofen: None declared, Christel Weiss: None declared, Christine Peine Shareholder of: Midaia GmbH, Felix Lang Shareholder of: Midaia GmbH, Johannes Knitza Consultant of: ABATON, Vila Health, Medac, Grant/research support from: ABATON, Jan Leipe: None declared

High-dose vitamin E supplementation does not diminish ribavirin-associated haemolysis in hepatitis C treatment with combination standard alpha-interferon and ribavirin

BACKGROUND

Ribavirin is associated with haemolytic anaemia. Antioxidants have been reported to decrease severity of this anaemia.

AIM

To determine effect of vitamin E supplementation on ribavirin-associated haemolysis in chronic hepatitis C treated with standard alpha-interferon and ribavirin.

METHODS

Fifty-one naive chronic hepatitis C patients were randomized to receive either alpha-interferon/ribavirin therapy (control) or therapy plus vitamin E 800 IU b.d. with 24-week follow-up. Alanine aminotransferase ALT, haemoglobin and reticulocyte percentage were monitored. Symptoms and health-related quality of life were also monitored at each visit.

RESULTS

Forty-seven subjects were treated (27 vitamin E /20 controls). Thirteen withdrew because of adverse effects or non-compliance. Groups were similar in demographics, genotype and baseline lab indices. Comparison with baseline, treatment and follow-up values showed a significant haemoglobin and ALT reduction in both groups. There was no significant difference in haemoglobin and reticulocyte percentage between groups. Sustained viral response was not significantly different between vitamin E (11/18) and control (6/16) groups. Three patients required ribavirin dose-reduction in the vitamin E group compared with two controls. Health-related quality of life during and end-of-treatment was not different between groups.

CONCLUSIONS

Vitamin E supplementation alone during standard alpha-interferon and ribavirin therapy does not appear to diminish ribavirin-associated haemolysis.

Nonsystemic vasculitic mononeuropathy multiplex, cryoglobulinemia, and hepatitis C

A 39-year-old man developed sequential acute mononeuropathies involving both median, both ulnar, and the right radial and left peroneal nerves. Electrophysiology demonstrated an asymmetric sensorimotor axonal polyneuropathy; nerve biopsy confirmed a vasculitis. Laboratory evaluation revealed a mixed cryoglobulinemia and active hepatitis C infection. The patient stabilized with prednisone/cyclophosphamide/interferon-alpha. Hepatitis C should be considered in the differential diagnosis of mononeuropathy multiplex. Accurate diagnosis is important, as interferon-alpha may prevent transition to chronic hepatitis/cirrhosis.