1
|
Bhavsar SV, Movahedi M, Cesta A, Pope JE, Bombardier C. Retention of triple therapy with methotrexate, sulfasalazine, and hydroxychloroquine compared to combination methotrexate and leflunomide in rheumatoid arthritis. Joint Bone Spine 2024; 91:105732. [PMID: 38583692 DOI: 10.1016/j.jbspin.2024.105732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE There are various combination conventional synthetic disease-modifying-antirheumatic drug (csDMARD) treatment strategies used in rheumatoid arthritis (RA). A commonly used csDMARD combination is triple therapy with methotrexate (MTX), sulfasalazine (SSZ) and hydroxychloroquine (HCQ). Another approach is double therapy with MTX and leflunomide (LEF). We compared the real-world retention of these two treatment combinations. METHODS Patients with RA from the Ontario Best Practices Research Initiative (OBRI) who received triple or double therapy on or after OBRI enrolment were included. Retention rates were compared between these two groups. We also analyzed which medication in the combination was discontinued and the reasons for treatment discontinuation. Disease activity was assessed at baseline, 6 and 12 months after treatment initiation as well as at time of discontinuation. Risk factors for treatment discontinuation were also examined. RESULTS Six hundred and ninety-two patients were included (258 triple and 434 double therapy). There were 175 (67.8%) discontinuations in the triple therapy group and 287 (66.1%) discontinuations in patients on double therapy. The median survival for triple therapy was longer (15.1 months; 95% CI: 11.2-21.2) compared to double therapy (9.6 months; 95%CI: 7.03-12.2). However, this was not statistically significant. Disease activity at 6 and 12 months, measured by 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) was lower with triple therapy (mean DAS28 at 6 months 3.4 vs. 3.9, P<0.0001 and at 12 months 3.2 vs. 3.5, P=0.0005). CONCLUSION Patients on triple therapy remained on treatment longer than patients on double therapy. However, this difference was not statistically significant.
Collapse
Affiliation(s)
| | - Mohammad Movahedi
- Ontario Best Practices Research Initiative (OBRI), Toronto General Research Institute University Health Network, Toronto, Canada; Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Canada.
| | - Angela Cesta
- Ontario Best Practices Research Initiative (OBRI), Toronto General Research Institute University Health Network, Toronto, Canada
| | - Janet E Pope
- Saint-Joseph's Health Care, 268, Grosvenor St, London, ON, Canada
| | - Claire Bombardier
- Ontario Best Practices Research Initiative (OBRI), Toronto General Research Institute University Health Network, Toronto, Canada; Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Guo N, Li X, Movahedi M, Cesta A, Bombardier C. Biologics initiation in moderate versus severe rheumatoid arthritis: real-world experience from a Canadian registry. Clin Exp Rheumatol 2024:19960. [PMID: 38372710 DOI: 10.55563/clinexprheumatol/mpevid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/28/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To evaluate the treat-to-target experience, and quality of life measures of moderate and severe rheumatoid arthritis (RA) patients initiating a biologic in a real-world setting of a publicly funded payer system. METHODS Biologic naive RA patients who had initiated their first biologic while enrolled in the Ontario Best Practices Research Initiative registry from 2008 to 2020 were selected if they had moderate (DAS28 >3.2 to ≤5.1) or severe (DAS28 >5.1) RA. Remission, LDA, DAS28, HAQ-DI, fatigue, sleep, drug persistence and characteristics associated with remission were assessed at 12 months post biologic initiation. RESULTS Overall, 838 patients initiated their first biologic, 264 had moderate RA and 219 had severe RA. After 12 months, 44% moderate RA vs. 21% severe RA achieved remission (p<0.0001), and 59% moderate RA vs. 35% severe RA reached LDA (p<0.0001). Mean change (SD) from baseline in DAS28 was 2.2 (1.5) in severe RA vs. 1.4 (1.3) in moderate RA (p<0.0001), in fatigue score was 1.11 (3.2) in severe RA vs. 0.98 (3.2) in moderate RA (p<0.0001). Moderate disease at a biologic initiation was positively associated with remission (p=0.0016). Female gender (p=0.0170), and a higher HAQ-DI score at baseline (p=0.0042) were negatively associated with remission. Biologic persistence was 77% for moderate, and 73% for severe (p=0.2444). CONCLUSIONS Severe RA patients had higher mean score improvements in DAS28, sleep and fatigue. Moderate RA was more likely to reach remission or LDA. Both groups had similar biologic persistence at 12 months. These findings highlight the importance of the treat-to-target approach and its potential underutilisation in the real-world setting.
Collapse
Affiliation(s)
- Nancy Guo
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario; AND Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario; and Department of Medicine, (DOM) and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Ontario, Canada.
| |
Collapse
|
3
|
Aboulenain S, Li X, Movahedi M, Bombardier C, Kuriya B. Cardiovascular Risk Factors and the Risk of Discontinuation of Advanced Therapies Due to Treatment Failure in Rheumatoid Arthritis: Results From the Ontario Best Practices Research Initiative. ACR Open Rheumatol 2023. [PMID: 37975266 DOI: 10.1002/acr2.11629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Our goal was to investigate whether cardiovascular disease (CVD) risk factors are associated with the retention of biologic disease-modifying antirheumatic drugs (bDMARDs) or targeted-synthetic DMARDs (tsDMARDs) in patients with rheumatoid arthritis (RA). METHODS We included participants in the Ontario Best Practices Initiative RA registry who initiated their first bDMARD or tsDMARD. Participants were grouped by the number of baseline CVD risk factors (0, 1, or ≥2). The primary outcome was time-to-discontinuation of therapy for any reason. Secondary outcomes included discontinuation for primary failure, secondary failure, or due to adverse events. Competing risks hazards model, adjusted for clinically important confounders, estimated the association between CVD risk factors and treatment retention. RESULTS The sample included 872 patients, of which 58% (n = 508) discontinued their b/tsDMARD after a median of 13 months from the time of initiation. The most common causes for treatment discontinuation were primary failure (n = 72), secondary failure (n = 126), or adverse events (n = 133). Patients with no CVD risk factors experienced significantly longer treatment survival compared to patients with 1 or ≥2 CVD risk factors. In multivariable-adjusted analysis, there was no association between all-cause discontinuation and CVD risk factors. However, there was a significant association between the presence of >1 CVD risk factor and treatment discontinuation, notably due to secondary treatment failure, but not due to adverse events. CONCLUSION Multiple CVD risk factors increase the risk of treatment failure in RA, particularly for secondary treatment failure. To improve patient outcomes, future research should focus on developing strategies to identify early treatment nonresponse and investigate the potential modifiability of this association.
Collapse
Affiliation(s)
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Bindee Kuriya
- Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Akhavan PS, Movahedi M, Cesta A, Bombardier C. Factors affecting the discrepancy between patient and physician global assessment in early rheumatoid arthritis: The Ontario Best Practices Research Initiative. Clin Exp Rheumatol 2023; 41:2249-2256. [PMID: 37382462 DOI: 10.55563/clinexprheumatol/r7b8go] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/17/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES We aimed to assess the prevalence and factors affecting the discrepancy between patient global assessment (PtGA) and physician global assessment of disease activity (PhGA) in patients with early rheumatoid arthritis (RA) at enrolment and after one year. METHODS Patients from the Ontario Best Practices Research Initiative (OBRI) were included. The discrepancy between PtGA and PhGA was calculated by simple subtraction (PtGA-PhGA). An absolute value ≥30 was considered discordant. Linear regression analysis was used to assess factors affecting PtGA, PhGA, and PtGA-PhGA discrepancy at enrolment and 1-year follow-up. RESULTS A total of 531 patients with mean disease duration of 0.3 years were analysed. The discordance prevalence was 22.4% at enrolment and 20.3% after one year. PtGA was higher in the majority of the discordant cases. Multivariable regression analysis showed higher PtGA was significantly associated with higher pain score, tender joint counts (TJC28), ESR, and fatigue at enrolment and 1-year follow-up while PtGA was associated with higher swollen joint counts (SJC28) only at enrolment. Similar associations were found for PhGA, with the exception of fatigue, which was not a significant factor at one year. Multivariable analysis showed that higher discrepancy between PtGA-PhGA was associated with lower SJC28 and higher pain score at enrolment and lower SJC28 and higher pain and fatigue score at 1-year follow-up. CONCLUSIONS Significant PtGA-PhGA discrepancy was found in approximately one-quarter of early RA patients. In the majority of these patients, PtGA was higher than PhGA. The main predictors of PtGA and PhGA remained the same after one year.
Collapse
Affiliation(s)
- Pooneh S Akhavan
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Canada.
| | - Mohammad Movahedi
- Ontario Best Practices Research Initiative (OBRI), Toronto General Research Institute University Health Network, Toronto, and Department of Medicine and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Canada
| | - Angela Cesta
- Ontario Best Practices Research Initiative (OBRI), Toronto General Research Institute University Health Network, Toronto, Canada
| | - Claire Bombardier
- Ontario Best Practices Research Initiative (OBRI), Toronto General Research Institute University Health Network, Toronto, and Department of Medicine and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Canada
| |
Collapse
|
5
|
Hazlewood GS, Akhavan P, Pardo JP, Agarwal A, Schieir O, Barber CEH, Proulx L, Richards DP, Bombardier C, Pope JE, Barnabe C, Tugwell P, Jamal S, Thorne JC, Nikolic RPA, Khraishi M, Bansback N, Legge A, Bykerk V, Taylor-Gjevre R. Canadian Rheumatology Association Living Guidelines for Rheumatoid Arthritis: Update #1. J Rheumatol 2023; 50:1198-1199. [PMID: 37527865 DOI: 10.3899/jrheum.2023-0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Glen S Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jordi Pardo Pardo
- Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Orit Schieir
- Canadian Early Arthritis Cohort Study, Toronto, Ontario, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shahin Jamal
- Division of Rheumatology, University of British Columbia, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - J Carter Thorne
- The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Roko P A Nikolic
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Majed Khraishi
- Department of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Nick Bansback
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Legge
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, Weill Cornell Medicine (Cornell University), New York, New York, USA
| | - Regina Taylor-Gjevre
- Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Manitoba, Canada
| |
Collapse
|
6
|
Movahedi M, Choquette D, Coupal L, Cesta A, Li X, Keystone EC, Bombardier C, Investigators O. Discontinuation of tofacitinib and TNF inhibitors in patients with rheumatoid arthritis: analysis of pooled data from two registries in Canada. BMJ Open 2023; 13:e063198. [PMID: 36878650 PMCID: PMC9990670 DOI: 10.1136/bmjopen-2022-063198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The similarity in retention of tumour necrosis factor inhibitors (TNFi) and tofacitinib (TOFA) was previously reported separately by the Ontario Best Practices Research Initiative and the Quebec cohort Rhumadata. However, because of small sample sizes in each registry, we aimed to confirm the findings by repeating the analysis of discontinuation of TNFi compared with TOFA, using pooled data from both these registries. DESIGN Retrospective cohort study. SETTING Pooled data from two rheumatoid arthritis (RA) registries in Canada. PARTICIPANTS Patients with RA starting TOFA or TNFi between June 2014 and December 2019 were included. A total of 1318 patients were included TNFi (n=825) or TOFA (n=493). OUTCOME MEASURES Time to discontinuation was assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. Propensity score (PS) stratification (deciles) and PS weighting were used to estimate treatment effects. RESULTS The mean disease duration in the TNFi group was shorter (8.9 years vs 13 years, p<0.001). Prior biological use (33.9% vs 66.9%, p<0.001) and clinical disease activity index (20.0 vs 22.1, p=0.02) were lower in the TNFi group.Discontinuation was reported in 309 (37.5%) and 181 (36.7%) TNFi and TOFA patients, respectively. After covariate adjustment using PS, there was no statistically significant difference between the two groups in discontinuation due to any reason HR=0.96 (95% CI 0.78 to 1.19, p=0.74)) as well as discontinuation due to ineffectiveness only HR=1.08 (95% CI 0.81 to 1.43, p=0.61)).TNFi users were less likely to discontinue due to adverse events (AEs) (adjusted HRs: 0.46, 95% CI 0.29 to 0.74; p=0.001). Results remained consistent for firstline users. CONCLUSIONS In this pooled real-world data study, the discontinuation rates overall were similar. However, discontinuation due to AEs was higher in TOFA compared with TNFi users.
Collapse
Affiliation(s)
- Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada
| | - Denis Choquette
- Department of Rheumatology, Institut de Rhumatologie de Montréal, Montreal, Québec, Canada
| | - Louis Coupal
- Department of Rheumatology, Institut de Rhumatologie de Montréal, Montreal, Québec, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Edward C Keystone
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- IHMPE, Univeristy of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Obri Investigators
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Rampakakis E, Thorne C, Cesta A, Movahedi M, Li X, Mously C, Ahluwalia V, Brophy J, Ciaschini P, Keystone E, Lau A, Major G, Pavlova V, Pope JE, Bombardier C. Medical cannabis use by rheumatology patients in routine clinical care: results from The Ontario Best Practices Research Initiative. Clin Exp Rheumatol 2023; 41:118-125. [PMID: 35616591 DOI: 10.55563/clinexprheumatol/b85xu5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/19/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Medical cannabis is often used to alleviate common symptoms in patients with chronic conditions. With cannabis legalisation in Canada and easier access, it is important that rheumatologists understand its potential impact on their practice. Among patients attending rheumatology clinics in Ontario we assessed: the prevalence of medical cannabis use; symptoms treated; rheumatologists' perceptions. METHODS Eight rheumatology clinics recruited consecutive adult patients in a 3-part medical cannabis survey: the first completed by rheumatologists; the second by all patients; the third by medical cannabis users. Student's t-test and Chi-square test were used to compare medical cannabis users to never users. RESULTS 799 patients participated, 163 (20.4%) currently using medical cannabis or within <2 years and 636 never users; most had rheumatoid arthritis (37.8%) or osteoarthritis (34.0%). Compared to never users, current/past-users were younger; more likely to be taking opioids/anti-depressants, have psychiatric/gastrointestinal disorders, and have used recreational cannabis (p<0.05); had higher physician (2.9 vs. 2.1) and patient (6.0 vs. 4.2) global scores, and pain (6.2 vs. 4.7) (p<0.0001). Pain (95.5%), sleeping (82.3%) and anxiety (58.9%) were the most commonly treated symptoms; 78.2% of current/past-users reported medical cannabis was at least somewhat effective. Most rheumatologists reported being uncomfortable to authorise medical cannabis, primarily due to lack of evidence, knowledge, and product standardisation. CONCLUSIONS Medical cannabis use among rheumatology patients in Ontario was two-fold higher than that reported for the general population of similar age. Use was associated with more severe disease, pain, and prior recreational use. Reported lack of research, knowledge, and product standardisation were barriers for rheumatologist use authorisation.
Collapse
Affiliation(s)
| | - Carter Thorne
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - XiuYing Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Carol Mously
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Vandana Ahluwalia
- Department of Rheumatology, Brampton Civic Hospital, William Osler Health System, Brampton, ON, Canada
| | | | | | - Edward Keystone
- The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital, Toronto, ON, Canada
| | - Arthur Lau
- Department of Medicine, Hamilton, ON, Canada
| | - Gerald Major
- Chair of Medical Cannabis Canada, Toronto, ON, Canada
| | | | - Janet E Pope
- Division of Rheumatology, Epidemiology and Biostatistics, Department of Medicine, Western University, London, ON, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto; The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital, Toronto, and Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
| |
Collapse
|
8
|
Wong-Pack M, Hepworth E, Movahedi M, Kuriya B, Pope J, Keystone E, Thorne C, Ahluwalia V, Cesta A, Mously C, Bombardier C, Lau A, Aydin SZ. Impact of the COVID-19 pandemic on patients with rheumatoid arthritis: data from the Ontario Best Practices Research Initiative (OBRI). Rheumatol Adv Pract 2023; 7:rkad042. [PMID: 37179654 PMCID: PMC10172034 DOI: 10.1093/rap/rkad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/09/2023] [Indexed: 05/15/2023] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic created challenges for patients with RA. We examined the potential impact of the pandemic on patient-reported outcomes (PROs), disease activity and medication profiles, comparing the periods pre-pandemic and during the pandemic. Methods Patients enrolled in the Ontario Best Practices Research Initiative were included if they had at least one visit to a physician or study interviewer within 12 months before and after the start of pandemic-related closures in Ontario (15 March 2020). Baseline characteristics, disease activity, PROs [i.e. health assessment questionnaire disability index, RA disease activity index (RADAI), European quality of life five-dimension questionnaire], medication use and changes were included. Student's paired two-sample t-tests and McNamar's tests were performed for continuous and categorical variables between time periods. Results The sample for analysis consisted of 1508 patients, with a mean (s.d.) age of 62.7 (12.5) years, and 79% were female. Despite decreases in the number of in-person visits during the pandemic, there was no significant negative impact on disease activity or PRO scores. The DASs in both periods remained low, with either no clinically significant differences or slight improvement. Scores for mental, social and physical health were either stable or improved. There were statistically significant decreases in conventional synthetic DMARD use (P < 0.0001) and increased Janus kinase inhibitor usage (P = 0.0002). Biologic DMARD use remained stable throughout the pandemic. Conclusion In this cohort, disease activity and PROs of RA patients remained stable during the COVID-19 pandemic. The longer-term outcomes of the pandemic warrant investigation.
Collapse
Affiliation(s)
- Matthew Wong-Pack
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Elliot Hepworth
- Division of Rheumatology, University of Ottawa, Ottawa, ON, Canada
| | - Mohammad Movahedi
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Bindee Kuriya
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Janet Pope
- Division of Rheumatology, University of Western Ontario, London, ON, Canada
| | - Edward Keystone
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carter Thorne
- Centre of Arthritis Excellence, Newmarket, ON, Canada
| | - Vandana Ahluwalia
- Division of Rheumatology, William Osler Health System, Brampton, ON, Canada
| | - Angela Cesta
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Carol Mously
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Claire Bombardier
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Arthur Lau
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Sibel Zehra Aydin
- Correspondence to: Sibel Zehra Aydin, Division of Rheumatology, Ottawa Hospital Riverside Campus, 1967 Riverside Drive, Ottawa, ON K1H 7W9, Canada. E-mail:
| |
Collapse
|
9
|
Li X, Cesta A, Movahedi M, Bombardier C. Late-onset rheumatoid arthritis has a similar time to remission as younger-onset rheumatoid arthritis: results from the Ontario Best Practices Research Initiative. Arthritis Res Ther 2022; 24:255. [DOI: 10.1186/s13075-022-02952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/04/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
The prevalence of rheumatoid arthritis (RA) in persons 60 years or older is estimated to be 2%. Late-onset rheumatoid arthritis (LORA) is traditionally defined as the onset of RA after the age of 60 years. Compared to younger-onset rheumatoid arthritis (YORA) which occurs before the age of 60 years, LORA has unique characteristics and disease manifestations. To date, few reports have addressed LORA and the prognosis of LORA patients remains unclear. We compared the clinical characteristics, time to remission and treatment regimen at remission between LORA and YORA patients.
Methods
This prospective cohort study used a registry database in Ontario, Canada from 2008 to 2020. Patients were included if they had active rheumatoid arthritis (RA) disease (≥1 swollen joint) and were enrolled within 1 year of diagnosis. LORA was defined as a diagnosis of RA in persons 60 years and older and YORA as a diagnosis of RA in persons under the age of 60. Remission was defined by Disease Activity Score 28 (DAS28) ≤2.6. A multivariable Cox proportional hazards model was used to estimate time to remission.
Results
The study included 354 LORA patients and 518 YORA patients. The mean (standard deviation) baseline DAS28 score was 5.0 (1.3) and 4.8 (1.2) in LORA and YORA patients, respectively (p=0.0946). Compared to YORA patients, the hazard ratio for remission in LORA patients was 1.10 (95% confidence interval 0.90 to 1.34 p=0.36) after adjusting for other prognostic factors. For patients who reached remission, LORA patients were less likely to be on a biologic or Janus kinase (JAK) inhibitor (16% vs. 27%) and more likely to be on a single conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) (34% vs. 27%) than YORA patients (p=0.0039).
Conclusion
LORA and YORA patients had similar prognosis in terms of time to remission. At remission, LORA patients were more likely to be on a single csDMARD without a biologic or JAK inhibitor.
Collapse
|
10
|
Pope J, Hall S, Bombardier C, Haraoui B, Jones G, Naik L, Etzel CJ, Ramey DR, Infante R, Miguelez M, Falcao S, Sahakian S, Wu D. Post-switch Effectiveness of Etanercept Biosimilar Versus Continued Etanercept in Rheumatoid Arthritis Patients with Stable Disease: A Prospective Multinational Observational Study. Adv Ther 2022; 39:5259-5273. [PMID: 36136243 DOI: 10.1007/s12325-022-02303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/16/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION To better inform clinicians about the use of etanercept biosimilar (SB4) in patients with rheumatoid arthritis (RA), COMPANION-B, a prospective real-world observational study, evaluated the effectiveness of the voluntary switch from originator (etanercept, ETN) to SB4 in patients with stable RA (low-disease activity/remission). METHODS The study recruited adult patients (18 years or older) with RA (2010 American College of Rheumatology criteria) prescribed ETN as their first or second biologic for at least 6 months across 14 sites in Canada and five in Australia. Patients had stable disease (Disease Activity Score-28 using erythrocyte sedimentation rate [DAS28-ESR] less than 3.2) at enrollment with no evidence of flare within the previous 3 months. Concomitant disease-modifying antirheumatic drugs (DMARDs) were permitted. Patients could elect to continue ETN or voluntarily switch to SB4 in consultation with their doctors. The primary effectiveness measure was the proportion of patients with disease worsening (defined as a DAS28-ESR increase of at least 1.2 from baseline and minimum score of at least 3.2 or a defined modification in RA treatment) during 12 months of follow-up. The secondary effectiveness measure was the proportion of patients with disease worsening at month 6. Serious adverse events (SAEs) and non-serious adverse reactions (NSARs) were recorded. RESULTS Of 163 patients enrolled, 109 elected to continue on ETN and 54 switched to SB4; 65.8% of patients received non-biologic DMARD(s), 52.6% methotrexate, and 10.5% oral corticosteroid(s). At month 12, the proportion of patients with disease worsening was comparable in the ETN group (22.8% [95% CI 15.0-32.2]) and SB4 group (17.6% [95% CI 8.4-30.9]). Similarly, the proportions of patients with disease worsening were also comparable at month 6 (ETN: 7.9% [95% CI 3.5-15.0]; SB4: 7.8% [95% CI 2.2-18.9]). SAEs were low and similar across both groups (ETN: 8.7%; SB4: 5.7%). NSARs were slightly higher in the SB4 vs. ETN group (13.2% vs. 2.9%). CONCLUSIONS SB4 demonstrated comparable effectiveness to ETN over 12 months in patients with stable RA who voluntarily switched to the biosimilar in a real-world setting.
Collapse
Affiliation(s)
- Janet Pope
- University of Western Ontario and St. Joseph's Hospital, London, ON, Canada.
| | | | | | - Boulos Haraoui
- Rheumatology Institute of Montreal, Université de Montréal, Montreal, QC, Canada
| | - Graeme Jones
- University of Tasmania-Lionheart Rheumatology, Hobart, TAS, Australia
| | - Latha Naik
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | | | - Maia Miguelez
- Otsuka Pharmaceutical Development & Commercialization, Inc., Montreal, QC, Canada
| | | | | | - David Wu
- Merck & Co., Kenilworth, NJ, USA
| |
Collapse
|
11
|
Hazlewood GS, Pardo JP, Barnabe C, Schieir O, Barber CEH, Proulx L, Richards DP, Tugwell P, Bansback N, Akhavan P, Bombardier C, Bykerk V, Jamal S, Khraishi M, Taylor-Gjevre R, Thorne JC, Agarwal A, Pope JE. Canadian Rheumatology Association Living Guidelines for the Pharmacological Management of Rheumatoid Arthritis With Disease-Modifying Antirheumatic Drugs. J Rheumatol 2022; 49:1092-1099. [PMID: 35840155 DOI: 10.3899/jrheum.220209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To provide the initial installment of a living guideline that will provide up-to-date guidance on the pharmacological management of patients with rheumatoid arthritis (RA) in Canada. METHODS The Canadian Rheumatology Association (CRA) formed a multidisciplinary panel composed of rheumatologists, researchers, methodologists, and patients. In this first installment of our living guideline, the panel developed a recommendation for the tapering of biologic and targeted synthetic disease-modifying antirheumatic drug (b/ts DMARD) therapy in patients in sustained remission using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach, including a health equity framework developed for the Canadian RA population. The recommendation was adapted from a living guideline of the Australia & New Zealand Musculoskeletal Clinical Trials Network. RESULTS In people with RA who are in sustained low disease activity or remission for at least 6 months, we suggest offering stepwise reduction in the dose of b/tsDMARD without discontinuation, in the context of a shared decision, provided patients are able to rapidly access rheumatology care and reestablish their medications if needed. In patients where rapid access to care or reestablishing access to medications is challenging, we conditionally recommend against tapering. A patient decision aid was developed to complement the recommendation. CONCLUSION This living guideline will provide contemporary RA management recommendations for Canadian practice. New recommendations will be added over time and updated, with the latest recommendation, evidence summaries, and Evidence to Decision summaries available through the CRA website (www.rheum.ca).
Collapse
Affiliation(s)
- Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada;
| | - Jordi Pardo Pardo
- J. Pardo Pardo, Ldo, Cochrane Musculoskeletal, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Barnabe
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Orit Schieir
- O. Schieir, PhD, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Claire E H Barber
- G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Professor, C.E.H. Barber, MD, PhD, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Laurie Proulx
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Dawn P Richards
- L. Proulx, B.Com, D.P. Richards, PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nick Bansback
- N. Bansback, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Pooneh Akhavan
- P. Akhavan, MD, MSc, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Claire Bombardier
- C. Bombardier, MD, Professor, Division of Rheumatology, Mount Sinai Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Bykerk
- V. Bykerk, MD, Professor, Hospital for Special Surgery, New York, New York, USA
| | - Shahin Jamal
- S. Jamal, MD, MSc, Clinical Associate Professor, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Majed Khraishi
- M. Khraishi, MD, Clinical Professor, Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Regina Taylor-Gjevre
- R. Taylor-Gjevre, MD, MSc, Professor, Division of Rheumatology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J Carter Thorne
- J.C. Thorne, MD, Assistant Professor, The Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | - Arnav Agarwal
- A. Agarwal, MD, Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Janet E Pope
- J.E. Pope, MD, MPH, Professor, Dept of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| |
Collapse
|
12
|
LI X, Cesta A, Movahedi M, Bombardier C. POS0539 LATE ONSET RHEUMATOID ARTHRITIS HAS A SIMILAR REMISSION RATE AS YOUNGER ONSET RHEUMATOID ARTHRITIS: RESULTS FROM THE ONTARIO BEST PRACTICES RESEARCH INITIATIVE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe prevalence of rheumatoid arthritis (RA) in persons 60 years or older is estimated to be 2%. Late onset rheumatoid arthritis (LORA) is a sub-group of patients traditionally defined as onset of RA after the age of 60 years. Compared to younger onset rheumatoid arthritis (YORA) which occurs before the age of 60 years, LORA has unique characteristics and disease manifestations. The prognosis of LORA patients is less clear based on prior studies.ObjectivesWe compared the clinical characteristics, time to remission and treatment regimen at remission between LORA and YORA patients.MethodsThe Ontario Best Practices Research Initiative (OBRI) is a clinical registry of RA patients followed in routine care. This analysis used the OBRI database from 2008 to 2020. Patients were included if they had active RA disease (≥1 swollen joint) and were enrolled in the study within 1 year of diagnosis. LORA was defined as diagnosis of RA after age of 60, YORA as under age of 60. Remission was defined by Disease Activity Score 28 (DAS28) ≤2.6. A multivariable Cox proportional hazards model was used to estimate time to remission.ResultsThe Ontario Best Practices Research Initiative (OBRI) is a clinical registry of RA patients followed in routine care. This analysis used the OBRI database from 2008 to 2020. Patients were included if they had active RA disease (≥1 swollen joint) and were enrolled in the study within 1 year of diagnosis. LORA was defined as diagnosis of RA after age of 60, YORA as under age of 60. Remission was defined by Disease Activity Score 28 (DAS28) ≤2.6. A multivariable Cox proportional hazards model was used to estimate time to remission.Table 1.Cox proportional hazards model predicting time to remissionBaseline characteristicsUnivariatep-valueMultivariablep-valueHR (95% CI)HR (95% CI)SociodemographicFemale gender0.71 (0.60-0.84)<.00010.87 (0.70-1.09)0.2256Post-secondary education1.26 (1.08-1.47)0.00391.04 (0.87-0.70)0.6744Ever smoked0.87 (0.75-1.02)0.0760.93 (0.77-1.12)0.4269RA family history0.89 (0.74-1.07)0.21760.87 (0.70-1.70)0.1817Disease characteristicsPositive rheumatoid factor1.01 (0.85-1.19)0.91820.94 (0.78-1.14)0.5381*HAQ-DI0.62 (0.55-0.69)<.00010.71 (0.61-0.84)<.0001Morning stiffness (>30 mins)0.71 (0.61-0.83)<.00010.89 (0.73-1.08)0.2366Joint erosion0.94 (0.77-1.14)0.52240.87 (0.70-1.08)0.1954DAS280.77 (0.72-0.82)<.00010.88 (0.80-0.96)0.0048Number of comorbidities0.83 (0.77-0.88)<.00010.88 (0.81-0.95)0.0019TreatmentBiologic or JAK inhibitor (time variant)0.86 (0.71-1.03)0.091.53 (0.63-3.69)0.3485LORA0.83 (0.71-0.97)0.01941.10 (0.90-1.34)0.3593*HAQ-DI = health assessment questionnaire disability indexFigure 1.Kaplan Meier survival curve of time to remission.ConclusionLORA and YORA patients had similar prognosis in terms of time to remission. At remission, LORA patients were more likely to be on a single csDMARD without biologic or JAK inhibitor. Clinicians should take the same approach for all RA patients targeting remission regardless of age of onset.References[1]Ruban TN, Jacob B, Pope JE, Keystone EC, Bombardier C, Kuriya B. The influence of age at disease onset on disease activity and disability: results from the Ontario Best Practices Research Initiative. Clinical rheumatology. 2016 Mar;35(3):759-63Disclosure of InterestsXiuying Li Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Janssen, Medexus, Merck, Novartis, and Pfizer, Angela Cesta Grant/research support from: The OBRI registry is funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: AbbVie, Amgen, Janssen, Merck, Novartis, and Pfizer, Mohammad Movahedi Grant/research support from: The OBRI registry is funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: AbbVie, Amgen, Janssen, Merck, Novartis, and Pfizer, Claire Bombardier Grant/research support from: The OBRI registry is funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: AbbVie, Amgen, Janssen, Merck, Novartis, and Pfizer.
Collapse
|
13
|
Movahedi M, Cesta A, Li X, Keystone EC, Bombardier C. Physician and Patient Reported Effectiveness are similar for Tofacitinib and TNFi in Rheumatoid Arthritis: Data from a Rheumatoid Arthritis Registry. J Rheumatol 2022; 49:447-453. [DOI: 10.3899/jrheum.211066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
Objective Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment and is one of several alternative treatments to tumor necrosis factor inhibitors (TNFi). We evaluated physician and patient- reported effectiveness of TNFi compared to TOFA, using real-world data from the Ontario Best Practices Research Initiative (OBRI). Methods Patients enrolled in the OBRI initiating TOFA or TNFi between 2014 and 2019 were included. Patients were required to have physician and patient-reported effectiveness outcomes data available at treatment initiation and 6 months later (± 2 months), which included clinical disease activity index (CDAI) and rheumatoid arthritis disease activity index (RADAI). To deal with confounding by indication, we estimated propensity scores (PS) for covariates. Results 419 patients were included. Of those, 226 initiated a TNFi and 193 TOFA, and had a mean (SD) disease duration of 8.0 (8.7) and 12.6 (9.6) years, respectively. In addition, the TNFi group was less likely to have prior biologic use (21.7%) compared to the TOFA group (67.9%). The proportion of patients in CDAI low disease activity (LDA)/remission at 6 months was 36.7% and 33.2% in the TNFi and TOFA groups, respectively. The generalized linear mixed models (GLMM) adjusting for PS quantile showed that there was no significant difference in CDAI LDA/remission (ORs: 0.85, 95% CI: 0.51, 1.43) and RADAI coefficient (0.48, 95% CI: -0.18, 1.14) between the two groups (Ref: TOFA). Conclusion In patients with RA, physician and patient-reported effectiveness are similar in TNFi and TOFA groups 6 months after treatment.
Collapse
|
14
|
Abstract
BACKGROUND Tophi develop in untreated or uncontrolled gout. This is an update of a Cochrane Review first published in 2014. OBJECTIVES: To assess the benefits and harms of non-surgical and surgical treatments for the management of tophi in gout. SEARCH METHODS We updated the search of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase databases to 28 August 2020. SELECTION CRITERIA We included all published randomised controlled trials (RCTs) or controlled clinical trials examining interventions for tophi in gout in adults. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included one trial in our original review. We added four more trials (1796 participants) in this update. One had three arms; pegloticase infusion every two weeks (biweekly), monthly pegloticase infusion (pegloticase infusion alternating with placebo infusion every two weeks) and placebo. Two studies looked at lesinurad 200 mg or 400 mg in combination with allopurinol. One trial studied lesinurad 200 mg or 400 mg in combination with febuxostat. One trial compared febuxostat 80 mg and 120 mg to allopurinol. Two trials were at unclear risk of performance and detection bias due to lack of information on blinding of participants and personnel. All other trials were at low risk of bias. Moderate-certainty evidence (downgraded for imprecision; one study; 79 participants) showed that biweekly pegloticase resolved tophi in 21/52 participants compared with 2/27 on placebo (risk ratio (RR) 5.45, 95% confidence interval (CI) 1.38 to 21.54; number needed to treat for a benefit (NNTB) 3, 95% CI 2 to 6). Similar proportions of participants receiving biweekly pegloticase (80/85) had an adverse event compared to placebo (41/43) (RR 0.99, 95% CI 0.91 to 1.07). However, more participants on biweekly pegloticase (15/85) withdrew due to an adverse event compared to placebo (1/43) (RR 7.59, 95% CI 1.04 to 55.55; number needed to treat for a harm (NNTH) 7, 95% CI 4 to 16). More participants on monthly pegloticase (11/52) showed complete resolution of tophi compared with placebo (2/27) (RR 2.86, 95% CI 0.68 to 11.97; NNTB 8, 95% CI 4 to 91). Similar numbers of participants on monthly pegloticase (84/84) had an adverse event compared to placebo (41/43) (RR 1.05, 95% CI 0.98 to 1.14). More participants on monthly pegloticase (16/84) withdrew due to adverse events compared to placebo (1/43) (RR 8.19, 95% CI 1.12 to 59.71; NNTH 6, 95% CI 4 to 14). Infusion reaction was the most common reason for withdrawal. Moderate-certainty evidence (2 studies; 103 participants; downgraded for imprecision) showed no clinically significant difference for complete resolution of target tophus in the lesinurad 200 mg plus allopurinol arm (11/53) compared to the placebo plus allopurinol arm (16/50) (RR 0.40, 95% CI 0.04 to 4.57), or in the lesinurad 400 mg plus allopurinol arm (12/48) compared to the placebo plus allopurinol arm (16/50) (RR 0.79, 95% CI 0.42 to 1.49). An extension study examined lesinurad 200 mg or 400 mg in combination with febuxostat, or placebo (low-certainty evidence, downgraded for indirectness and imprecision). Participants on lesinurad in the original study continued (CONT) on the same dose. Lesinurad 400 mg plus febuxostat may be beneficial for tophi resolution; 43/65 in the lesinurad 400 mg CONT arm compared to 38/64 in the lesinurad 200 mg CONT arm had tophi resolution (RR 1.11, 95% CI 0.85 to 1.46). Lesinurad 400 mg plus febuxostat may result in no difference in adverse events; 57/65 in the lesinurad 400 mg CONT arm had an adverse event compared to 50/64 in lesinurad 200 mg CONT arm (RR 1.12, 95% CI 0.96 to 1.32). Lesinurad 400 mg plus febuxostat may result in no difference in withdrawals due to adverse events; 10/65 participants in the lesinurad 400 mg CONT arm withdrew due to an adverse event compared to 10/64 participants in the lesinurad 200 mg CONT arm (RR 0.98, 95% CI 0.44 to 2.20). Lesinurad 400 mg plus febuxostat may result in no difference in mean serum uric acid (sUA), which was 3 mg/dl in the lesinurad 400 mg CONT group compared to 3.9 mg/dl in the lesinurad 200 mg CONT group (mean difference -0.90, 95% CI -1.51 to -0.29). Participants who were not on lesinurad in the original study were randomised (CROSS) to lesinurad 200 mg or 400 mg, both in combination with febuxostat. Low-certainty evidence downgraded for indirectness and imprecision showed that lesinurad 400 mg (CROSS) may result in tophi resolution (17/34) compared to lesinurad 200 mg (CROSS) (14/33) (RR 1.18, 95% CI 0.70 to 1.98). Lesinurad 400 mg in combination with febuxostat may result in no difference in adverse events (33/34 in the lesinurad 400 mg CROSS arm compared to 27/33 in the lesinurad 200 mg (CROSS); RR 1.19, 95% CI 1.00 to 1.41). Lesinurad 400 mg plus febuxostat may result in no difference in withdrawals due to adverse events, 5/34 in the lesinurad 400 mg CROSS arm withdrew compared to 2/33 in the lesinurad 200 mg CROSS arm (RR 2.43, 95% CI 0.51 to 11.64). Lesinurad 400 mg plus febuxostat results in no difference in sUA (4.2 mg/dl in lesinurad 400 mg CROSS) compared to lesinurad 200 mg (3.8 mg/dl in lesinurad 200 mg CROSS), mean difference 0.40 mg/dl, 95% CI -0.75 to 1.55. AUTHORS' CONCLUSIONS Moderate-certainty evidence showed that pegloticase is probably beneficial for resolution of tophi in gout. Although there was little difference in adverse events when compared to placebo, participants on pegloticase had more withdrawals due to adverse events. Lesinurad 400 mg plus febuxostat may be beneficial for tophi resolution compared with lesinurad 200 mg plus febuxostat; there was no difference in adverse events between these groups. We were unable to determine whether lesinurad plus febuxostat is more effective than placebo. Lesinurad (400 mg or 200 mg) plus allopurinol is probably not beneficial for tophi resolution, and there was no difference in adverse events between these groups. RCTs on interventions for managing tophi in gout are needed, and the lack of trial data is surprising given that allopurinol is a well-established treatment for gout.
Collapse
Affiliation(s)
- Melonie K Sriranganathan
- Rheumatology Service, Department of General Medicine, Changi General Hospital, Singapore City, Singapore
| | - Ophir Vinik
- Division of Rheumatology, St Michael's Hospital, Toronto, Canada
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, Canada
| | - Claire Bombardier
- Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Christopher J Edwards
- Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
15
|
Hazlewood GS, Bombardier C, Li X, Movahedi M, Choquette D, Coupal L, Bykerk V, Schieir O, Mosher D, Marshall DA, Bernatsky S, Spencer N, Richards DP, Proulx L, Barber CEH. Heterogeneity in patient characteristics and differences in treatment across four Canadian rheumatoid arthritis cohorts. J Rheumatol 2021; 49:16-25. [PMID: 34334357 DOI: 10.3899/jrheum.201688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare clinical characteristics and treatment of patients with rheumatoid arthritis (RA) across 4 Canadian cohorts. METHODS The four longitudinal cohorts included: The Canadian Early Arthritis Cohort (CATCH) (n=2878); Ontario Best Practices Research Initiative (OBRI) (n=3734); RHUMADATA® (Quebec, n=2890), and the Rheum4U Precision Health Registry (Calgary, n=709). Data were from cohort inception (range 1998-2016) to 2020. Clinical characteristics and drug treatments were summarized descriptively. RESULTS 10,211 patients with RA were included. The percentage of patients who entered the cohort with early RA ( ≤ 2 years of disease at enrolment) ranged from 29% (Rheum4U) to 100% (CATCH). Mean age (55 years), sex (74% female) and seropositivity (69%) were similar between cohorts. At the time of initial disease modifying anti-rheumatic drug (DMARD) use, median disease activity scores (DAS-28) varied, ranging from 2.99 (Rheum4U) to 5.19 (CATCH), but were more similar at the time of the first DMARD switch (range:3.57-5.03), first biologic or targeted synthetic DMARD (bDAMRD, tsDMARD) use (range:4.01-4.67) and second bDAMRD or tsDMARD (range:3.71-4.39). The initial DMARD was most commonly methotrexate, either in monotherapy (32%, range:18%-40%) or dual therapy (34%, range:29%- 42%). The first DMARD switch was to another DMARD monotherapy in 20% (range:10%- 32%), dual therapy in 49% (range:39%-56%), and bDMARD or tsDMARD in 24% (range:15%- 28%). The first bDMARD was an anti-TNF in 79% (range:78%-85%). CONCLUSION Canadian RA cohorts demonstrate some heterogeneity in treatment which could reflect differences in inclusion criteria, calendar year, or regional differences. This project is a first step towards conducting harmonized analyses across Canadian RA cohorts.
Collapse
Affiliation(s)
- Glen S Hazlewood
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Claire Bombardier
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Xiuying Li
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Mohammad Movahedi
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Denis Choquette
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Louis Coupal
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Vivian Bykerk
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Orit Schieir
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Dianne Mosher
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Deborah A Marshall
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Sasha Bernatsky
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Nicole Spencer
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Dawn P Richards
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | - Laurie Proulx
- Department of Medicine, University of Calgary; Department of Community Health Sciences, University of Calgary; Arthritis Research Canada; McCaig Institute for Bone and Joint Health; Department of Medicine University of Toronto; Toronto General Research Institute; Ontario Best Practices Research Initiative (OBRI); Institute of Health Policy, Management and Evaluation, University of Toronto; Université de Montréal, CHUM; RHUMADATA®; Hospital for Special Surgery, Weill Cornell Medical College; Canadian Early Arthritis Cohort (CATCH); Department of Medicine, McGill University; Canadian Arthritis Patient Alliance. Funding: This project was funded by an Arthritis Alliance of Canada Legacy Award. GSH is supported by a Canadian Institutes of Health Research New Investigator Award. CEHB has an Arthritis Stars Career Development Award, funded by the Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis STAR-19-0611/CIHR SI2-169745. DAMar is supported by the Arthur J.E. Child Chair in Rheumatology and a Canada Research Chair in Health Systems and Services Research (2008-2018). The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013; Eli Lilly Canada since 2016, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019 and Gilead Sciences Canada since 2020. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, and Sanofi Genzyme from 2016-2017. OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC ), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Celgene, Hospira, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. The Rheum4U Program is supported by unrestricted educational grants from the following pharmaceutical companies: AbbVie; Amgen; Bristol-Myers Squibb (BMS); Celgene; Janssen; Merck; Novartis; Pfizer;Roche; Sanofi; Sandoz; Swedish Orphan Biovitrum AB (publ) (Sobi); and Union Chimique Belge (UCB). Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli LillyCanada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada. Conflicts of interest: The following authors declare potential conflicts of interest. D Choquette: AbbVie Canada, Amgen Canada, Eli Lilly Canada, Merk Canada, Novartis Canada, Pfizer Canada, Sandoz Canada, Sanofi-Genzyme Canada. V Bykerk: Consultant for Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB. The remainder of the authors declared no conflicts. Address correspondence to Glen Hazlewood MD PhD, , 3280 Hospital Drive NW, HMRB Building, Room 451, Calgary, AB T2N 4N1
| | | | | |
Collapse
|
16
|
Keystone E, Movahedi M, Cesta A, Bombardier C, Sampalis JS, Rampakakis E. Differential influence of Clinical Disease Activity Index components based on disease state in rheumatoid arthritis patients: real-world results from the Ontario Best Practices Research Initiative. Clin Exp Rheumatol 2021; 40:2147-2152. [DOI: 10.55563/clinexprheumatol/86frzq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Edward Keystone
- Department of Rheumatology, University of Toronto, ON, Canada
| | - Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine (DMO) University of Toronto and Institute of Health Policy, Management, and Evaluation (IHPME), Toronto, and Mount Sinai Hospital, Division of Rheumatology, Toronto, ON, Canada
| | - John S. Sampalis
- JSS Medical Research, St-Laurent, and Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | |
Collapse
|
17
|
Power JD, Glennie A, Rogers S, Aziz M, Singh S, Dandurand C, Tauh S, Richard-Denis A, Morris S, Richard-Denis A, Lim V, Mputu PM, Soroceanu A, Sadiq I, Daly C, Dandurand C, Larouche J, Correale M, Sharma A, Charest-Morin R, Lee J, Ajoku U, Moskven E, Asif H, Al-attar ENM, Mishreky A, Rocos B, Rocos B, Rocos B, Srivastava SK, Patgaonkar P, Cummins D, Bednar D, Chan V, Bowker R, Evaniew N, Hathi K, Hall H, Ludwig T, Ludwig T, Truong VT, Passalent L, Wang S, Shaikh N, Pelletier-Roy R, Shen J, Wang Z, Singh S, Machida M, Machida M, Fernandes R, Fernandes R, Marathe N, Kerr J, Magnan MC, Visva S, Jarvis J, Jarvis J, Jentzsch T, Cherry A, Cherry A, Cherry A, Dandurand C, Rampersaud R, Sundararajan K, Levasseur A, Fernandes R, Fernandes R, Fullerton K, Malone H, Daly C, Peloza J, Peloza J, Walden K, Elsemin O, MacLean MA, Rose J, Oppermann M, Ferguson D, Hindi M, Dermott JA, DeVries Z, Lebel D, Ayling O, Singh V, Craig M, Lasswell T, Perruccio AV, Canizares M, McIntosh G, Rampersaud YR, Urquhart J, Koto P, Rasoulinejad P, Sequeira K, Miller T, Watson J, Rosedale R, Gurr K, Siddiqi F, Bailey C, Manson N, Bigney E, Vandewint A, Richardson E, El-Mughayyar D, McPhee R, Abraham E, Weber M, McIntosh G, Kelly A, Santaguida C, Ouellet J, Reindl R, Jarzem P, Lasry O, Dea N, Fisher C, Street J, Boyd M, Charest-Morin R, Rhines L, Boriani S, Charest-Morin R, Gokaslan Z, Gasbarrini A, Saghal A, Laufer II, Lazary A, Bettegowda C, Kawahara N, Clarke M, Rampersaud YR, Reynolds J, Disch A, Chou D, Shin JH, Wei F, Hornicek FJ, Barzilai O, Fisher C, Dea N, Nickel D, Thorpe L, Brown J, Weiler R, Linassi G, Fourney D, Dionne A, Bégin J, Mac-Thiong JM, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore GW, Laule C, Kwon B, Gravel LF, Dionne A, Bourassa-Moreau E, Maurais G, Khoueir P, Mac-Thiong JM, Richard-Denis A, Dionne A, Bourassa-Moreau É, Bégin J, Mac-Thiong JM, Beausejour M, Richard-Denis A, Begin J, Dionne A, Mac-Thiong JM, Scheer J, Protopsaltis T, Gupta M, Passias P, Gum J, Smith J, Bess S, Lafage V, Ames C, Klineberg E, Frederick A, Nicholls F, Lewkonia P, Thomas K, Jacobs B, Swamy G, Miller N, Tanguay R, Soroceanu A, Nevin J, Bourassa-Moreau E, Dvorak M, Fisher C, Paquette S, Kwon B, Dea N, Ailon T, Charest-Morin R, Street J, Hindi M, Kwon B, Dvorak M, Ailon T, Paquette S, Fisher C, Charest-Morin R, Dea N, Street J, Finkelstein J, Bowes J, Ford M, Yee A, Soever L, Rachevitz M, Bigness A, Robertson S, Wilson R, Wong W, Nugent J, Frantzeskos S, Duffy M, Rampersaud R, Marathe N, Agarwal R, Bailey CS, Paquet J, Dea N, Goytan M, McIntosh G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Hall H, Bailey C, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, McIntosh G, Abraham E, Glennie A, Jarzem P, Ahn H, Blanchard J, Hogan G, Kelly A, Charest-Morin R, Tohidi M, Hopman W, Yen D, Parent S, Miyanji F, Murphy J, El-Hawary R, Lebel D, Zeller R, Reda L, Dodds M, Lebel D, Zeller R, Zeller R, Marathe N, Bhosale S, Raj A, Marathe N, Goyal V, Theologis A, Witiw C, Fehlings M, Morash K, Yaszay B, Andras L, Sturm P, Sponseller P, El-Hawary R, Swamy G, Jacobs WB, Bouchard J, Cho R, Manson NA, Rampersaud YR, Paquet J, Bailey CS, Johnson M, Attabib N, Fisher CG, McIntosh G, Thomas KC, Bigney E, Richardson E, Alugo T, El-Mughayyar D, Vandewint A, Manson N, Abraham E, Attabib N, Prostko R, Cheng B, Haring K, Fischer M, Bourget-Murray J, Sridharan S, Frederick A, Johnston K, Edwards B, Nicholls F, Soroceanu A, Bouchard J, Shedid D, Al-Shakfa F, Shen J, Boubez G, Yuh SJ, Wang Z, Sundararajan K, Perruccio A, Coyte P, Bombardier C, Bloom J, Hawke C, Haroon N, Inman R, Rampersaud YR, Hebert J, Abraham E, Vandewint A, Bigney E, Richardson E, El-Mughayyar D, Attabib N, Small C, Manson N, Zhang H, Beresford-Cleary N, Street J, Wilson D, Oxland T, Richard-Denis A, Jean S, Bourassa-Moreau É, Fleury J, Beauchamp-Vien G, Bégin J, Mac-Thiong JM, Boudier-Revéret M, Majdalani C, Truong VT, Wang Z, Shedid D, Najjar A, Yuh SJ, Boubez G, Sebaaly A, McIntosh G, Ailon T, Dea N, Fisher C, Charest-Morin R, Lebel D, Rocos B, Zabjek K, Zeller R, Zabjek K, Rocos B, Lebel D, Zeller R, Gee A, Schneider N, Kanawati A, Schemitsch E, Bailey C, Rasoulinejad P, Zdero R, Schneider N, Gee A, Kanawati A, Zdero R, Bailey C, Rasoulinejad P, Lohkamp LN, Fehlings M, Abraham E, Vandewint A, Bigney E, Hebert J, Richardson E, El-Mughayyar D, Chorney J, El-Hawary R, Manson N, Wai E, Phan P, Kingwell S, Tierney S, Stratton A, AlDuwaisan A, Moravek D, Wai E, Kingwell S, Stratton A, Phan P, Devries Z, Barrowman N, Smit K, Tice A, Devries Z, Barrowman N, Smit K, Tice A, Sundararajan K, Rampersaud YR, Oitment C, Wunder J, Ferguson P, Rampersaud R, Rampersaud R, Rampersaud R, Ailon T, Dvorak M, Kwon B, Paquette S, Charest-Morin R, Dea N, Fisher C, Street J, Bailey C, Casha S, Glennie A, Fox R, McIntosh G, Yee A, Fisher C, Perruccio A, Perruccio A, Rampersaud YR, Mac-Thiong JM, Richard-Denis A, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Klein G, Emmenegger U, Finkelstein J, Lyons F, Whyne C, Hardisty M, Millgram M, Guyer R, Harel R, Ashkenazi E, Dvorak M, Fisher C, Paquette S, Street J, Dea N, Ailon T, Charest-Morin R, Kwon B, Millgram M, Guyer R, Le Huec JC, Ashkenazi E, Millgram M, Guyer R, Harel R, Kutz S, Ashkenazi E, Parsons J, Bailey CS, Dhaliwal P, Fourney DR, Noonan V, Mac-Thiong JM, Beausejour M, Sassine S, Joncas J, Barchi S, Le May S, Cobetto N, Fortin C, Carl-Éric A, Parent S, Labelle H, Bailey C, Fisher C, Rampersaud R, Glennie A, Manson N, Bigney E, Vandewint A, Hebert J, El-Mughayyar D, Richardson E, Ghallab N, Flood M, Attabib N, Abraham E, Swamy G, Nicholls F, Thomas K, Jacobs WB, Soroceanu A, Evaniew N, Stevens M, Dunning C, Oxner W, Glennie A, Dandurand C, Paquette S, Kwon B, Ailon T, Dvorak M, Dea N, Charest-Morin R, Fisher C, Street J, Kim D, Lebel DE, Jarvis J, Tice A, Smit K, Campbell F, Mashida M, Isaac L, Bath N, Stocki D, Levin D, Koyle M, Ruskin D, Stinson J, Ailon T, Dea N, Fisher C, Evaniew N, Soroceanu A, Nicholls F, Jacobs WB, Thomas K, Cho R, Lewkonia P, Swamy G, Lasry O, Ailon T, Zamani N, Rampersaud R, Rasoulinejad P. 2021 Canadian Spine Society Abstracts. Can J Surg 2021; 64:S1-S36. [PMID: 34296831 PMCID: PMC8410468 DOI: 10.1503/cjs.012621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
18
|
Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the Gap between Symptom Onset and Diagnosis in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2021; 74:997-1005. [PMID: 34268914 DOI: 10.1002/acr.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a stratified screening process for early identification of axial spondyloarthritis (axSpA) considering: 1) wait times from primary care to rheumatology screen; 2) incremental precision and accuracy from primary care to rheumatology screen; and 3) diagnostic delay. METHODS Adults with low back pain (LBP) attending primary care LBP clinics prospectively underwent a primary standardized clinical screen. Patients with LBP >3 months and onset age <50 years were referred for a comprehensive secondary screen by a physiotherapist with advanced rheumatology training. At secondary screening, patients with inflammatory features were deemed to have a low, medium, or high risk of axSpA vs. no risk. Precision and accuracy of this screening strata were measured against a rheumatologist with axSpA expertise. RESULTS In all, 405 patients underwent primary and secondary screening. Mean age was 36.9 years (±9.9); 55% were female. HLA-B27 was present in 14.4%. Median wait time from primary to secondary screen was 15 days. AxSpA risk assignment by rheumatologist was: 64.9% (none or low risk axSpA) and 35.1% (medium or high risk axSpA). The best combination of sensitivity (68%), specificity (90%), positive (80%) and negative (84%) predictive values was evident with the secondary screen. 15.6% of patients received a final diagnosis of axSpA. Median LBP duration from onset to diagnosis was: 2 years (non-radiographic axSpA) and 7 years (ankylosing spondylitis). CONCLUSION A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA.
Collapse
Affiliation(s)
- Laura Passalent
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kala Sundararajan
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network Toronto, Toronto, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Evaluation Unit, University Health Network, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christopher Hawke
- Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeff A Bloom
- Family and Community Medicine, University Health Network, Toronto, Canada
| | - Nigil Haroon
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert D Inman
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Departments of Medicine and Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
19
|
Movahedi M, Cesta A, Li X, Keystone E, Bombardier C. POS0445 PHYSICIAN AND PATIENT REPORTED EFFECTIVENESS OUTCOMES ARE SIMILAR IN TOFACITINIB AND TNF INHIBITORS IN RHEUMATOID ARTHRITIS PATIENTS: DATA FROM A RHEUMATOID ARTHRITIS REGISTRY IN CANADA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment as an alternative option to biologic disease modifying antirheumatic drugs (bDMARDs) including tumor necrosis factor inhibitors (TNFi).Objectives:We aimed to evaluate physician and patient reported effectivness outcomes in TNFi compared to TOFA, using real-world data from the Ontario Best Practices Research Initiative (OBRI).Methods:RA patients enrolled in the OBRI initiating their TOFA or TNFi (Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab, and Biosimilars) between 1st June 2014 (TOFA approval date in Canada) and 31st Dec 2019 were included. Patients were required to have physician and patient reported effectivness outcomes data available at treatment initiation and 6-month (± 2 months) follow-up. These included clinical disease activity index (CDAI), rheumatoid arthritis disease activity index (RADAI), HAQ-DI, sleep problem, and anxiety/depression scores. Multiple imputation (Imputation Chained Equation, N=20) was used to deal with missing data for covaraites at treatment initiation. To deal with confounding by indication, we estimated propensity scores for covariates with an absolute standard difference greater than 0.1 between the two treatment groups.Results:A total of 419 patients were included. Of those, 226 were initiating a TNFi and 193 TOFA, and had a mean (SD) disease duration of 8.0 (8.7) and 12.6 (9.6) years, respectively. In the TNFi group, 81.9% were female and mean age (SD) at treatment initiation was 56.6 (13.4) years. In the TOFA group, 85% were female and mean (SD) age at treatment initiation was 60.3 (11.2) years. The TNFi group was less likely to have prior biologic use (21.7%) compared to the TOFA group (67.9%). At treatment initiation, physical function measured by HAQ-DI was significantly lower in TNFi compared to the TOFA group (1.2 vs.1.4).The rate of CDAI LDA/remission at 6 months was 36.7% and 33.2% in TNFi and TOFA group, respectively. The generalized linear mixed models (GLMM) adjusting for propensity score quantile, showed that there was no significant difference in CDAI LDA/remission (ORs: 0.85, 95% CI: 0.51, 1.43), RADAI (coefficient: 0.48, 95% CI: -0.18, 1.14), HAQ-DI (coefficient: -0.01, 95% CI: -0.18, 0.16), sleep problems (coefficient: -0.25, 95% CI: -0.95, 0.45), and anxiety/depression scores (coefficient: 0.12, 95% CI: -0.35, 0.58) between the two treatment groups (TOFA used as reference).Conclusion:In this real-world data study, we found that, physician and patient reported effectivness outcomes are similar in the TNFi and TOFA groups 6 months after treatment initiation in patients with RA.Disclosure of Interests:Mohammad Movahedi: None declared, Angela Cesta: None declared, Xiuying Li: None declared, Edward Keystone Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, PuraPharm. Speaker Honoraria Agreements: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis. Consulting Agreements/Advisory Board Membership: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Claire Bombardier Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Aurora, Bristol-Meyers Squibb, Celgene, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB. Dr. Bombardier held a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and a Pfizer Research Chair in Rheumatology
Collapse
|
20
|
Movahedi M, Choquette D, Coupal L, Cesta A, Li X, Keystone E, Bombardier C. POS0448 DISCONTINUATION RATE OF TOFACITINIB AS MONOTHERAPY IS SIMILAR COMPARED TO COMBINATION THERAPY WITH METHOTREXATE IN RHEUMATOID ARTHRITIS PATIENTS: POOLED DATA FROM TWO RHEUMATOID ARTHRITIS REGISTRIES IN CANADA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment and is prescribed alone or with methotrexate (MTX). We previously reported the similarity in retention between TOFA monotherapy and TOFA with MTX using data from two different registries separately; the Ontario Best Practices Research Initiative (OBRI) and the Quebec registry RHUMADATA.Objectives:To increase the study power, we propose to evaluate the discontinuation rate (due to any reason) of TOFA with and without MTX, using pooled data from these two registries.Methods:RA patients enrolled in the OBRI and RHUMADATA initiating their TOFA between 1st June 2014 (TOFA approval date in Canada) and 31st Dec 2019 were included. Concurrent MTX use was defined as MTX use for more than 75% of the time while using TOFA. Multiple imputation (Imputation Chained Equation method, N=20) was used to deal with missing data for covariates at treatment initiation.Time to discontinuation was assessed using Cox regression models. To deal with confounding by indication, we estimated propensity scores for selected covariates with an absolute standard difference greater than 0.1. We then adjusted Cox regression models for propensity quantile to compare the discontinuation of TOFA with MTX versus TOFA without MTX.Results:A total of 493 patients were included. Of those, 244 (49.5%) and 249 (51.5%) were treated with MTX and without MTX, respectively. Compared to TOFA monotherapy, the TOFA with MTX group had a significantly lower mean HAQ-DI, fatigue score, and the number of prior biologic use at the time of TOFA initiation. A lower proportion of positive ACPA (59% vs. 66%), prevalence of hypertension (31% vs 37%), and concomitant use of Leflunomide (11% vs. 23%) were also observed for patients using TOFA with MTX.Over a mean follow-up of 19.0 months, discontinuation was reported in 182 (36.9%) of all TOFA patients. After adjusting for propensity score quantile across 20 imputed datasets, there was no significant difference in discontinuation between treatment groups (adjusted HRs: 1.12, 95% CI: 0.83-1.51; p=0.49).Conclusion:In this pooled real-world data study, we found that in patients with RA, the retention of TOFA is similar if it is used as monotherapy or in combination with MTX.Disclosure of Interests:Movahedi: None declared, Denis Choquette Grant/research support from: Rhumadata is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli Lilly Canada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada., Louis Coupal: None declared, Angela Cesta: None declared, Xiuying Li: None declared, Edward Keystone Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, PuraPharm. Speaker Honoraria Agreements: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis. Consulting Agreements/Advisory Board Membership: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Claire Bombardier Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Aurora, Bristol-Meyers Squibb, Celgene, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB.Acknowledgment: :Dr. Bombardier held a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and a Pfizer Research Chair in Rheumatology
Collapse
|
21
|
Guo N, Li X, Movahedi M, Cesta A, Bombardier C. POS0449 BIOLOGICS INITIATION IN MODERATE VS SEVERE RHEUMATOID ARTHRITIS PATIENTS: PROSPECTIVE OBSERVATIONAL STUDY FROM A CANADIAN REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Prior studies have shown that in the real-world setting, rheumatoid arthritis (RA) patients have lower disease activity than those studied in clinical trials. However, randomized controlled trials for biologics continue to mainly recruit patients with severe disease.Objectives:To assess the implications of this practice, our study investigates the proportion of patients achieving remission (DAS28-ESR ≤ 2.6), in RA patients with moderate disease activity and severe disease activity, at 12 months post starting their first biologic, and identifies baseline predictors of biologic response.Methods:This study included RA patients who have never been treated with a biologic and initiated their first biologic while enrolled in the Ontario Best Practices Research Initiative (OBRI) registry, between 2008 and 2019. Patients selected had either moderate RA (DAS28 ≥ 3.2 to ≤ 5.1) or severe RA (DAS28 > 5.1). Comparisons were made between the moderate and severe disease groups using the student’s t-test for continuous variables, and the chi-square test for categorical variables. Multivariable logistic regression was used to test potential predictors of remission. Backward stepwise model selection was applied to select variables with p-value ≤0.10. Multiple imputation (MCMC method; n=20) was used to impute missing data.Results:Overall, 641 patients initiated their first biologic, 483 had follow up data at 12 months (moderate disease activity=264; severe disease activity=219). In the moderate group, the mean age (SD) was 55.7 (13.1) and 80% were female. In the severe group, mean age (SD) was 58.4 (12.3) and 81% were female. At time of biologic initiation, the mean DAS28 for the moderate group was 4.1 (0.5), and 6.0 (0.6) for the severe group. After 12 months of starting a biologic, the proportion of patients achieving remission was 50% in the moderate group, and 23% in the severe group (p<0.0001). In contrast, the proportion of patients achieving significant clinical change from baseline (improvement in DAS28 ≥ 1.2) was 78% in the severe group, compared to 66% in the moderate group (p=0.0049). More specifically, the absolute improvement in DAS28 after 12 months was higher in the severe group at 2.2 (1.5), compared to a change of 1.4 (1.3) in the moderate group (p<0.0001). Negative predictors of remission include female gender (odds ratio (OR), 0.57, 95% confidence interval (CI), 0.33-0.97; p=0.039), and higher HAQ-DI score (OR 0.49, 95% CI 0.36-0.68; p<0.001). In turn, moderate disease at time of biologic initiation (OR 2.38, 95% CI 1.50-3.79; p=0.0390) was identified as a positive predictor of remission.Conclusion:This prospective cohort study found RA patients with moderate disease activity are more likely to reach targeted states (remission and low disease activity), whereas severe patients have greater absolute improvements in DAS28 and HAQ-DI but are less likely to achieve remission. Moderate disease is a positive predictor for remission, whereas female gender and a higher HAQ-DI score are negative predictors.Table 1.Logistic regression analysis for the rate of achieving DAS28 low disease activity at six months.Moderate-RA(n=264)Severe-RA(n=219)P-ValueRemission, n (%)111 (50)45 (23)<0.0001Low disease activity, n (%)151 (59)74 (35)<0.0001Change in DAS from baseline ≥ 1.2, n (%)168 (66)164 (78)0.0049HAQ-DI change >0.22, n (%)98 (53)83 (52)0.7974Change in DAS28 from baseline, mean (SD)-1.4 (1.3)-2.2 (1.5)<0.0001Change in HAQ-DI from baseline, mean (SD)-0.29 (0.57)-0.30 (0.66)<0.0001Change in fatigue from baseline, mean (SD)-0.98 (3.2)-1.11 (3.2)<0.0001Change in sleep from baseline, mean (SD)-0.85 (3.6)-1.05 (3.9)0.0004Disclosure of Interests:Nancy Guo: None declared, Xiuying Li: None declared, Mohammad Movahedi: None declared, Angela Cesta: None declared, Claire Bombardier Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Aurora, Bristol-Meyers Squibb, Celgene, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB.Acknowledgment: :Dr. Bombardier held a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and a Pfizer Research Chair in Rheumatology
Collapse
|
22
|
Movahedi M, Choquette D, Coupal L, Cesta A, LI X, Keystone E, Bombardier C. OP0179 DISCONTINUATION RATE OF TOFACITINIB IS SIMILAR WHEN COMPARED TO TNF INHIBITORS IN RHEUMATOID ARTHRITIS PATIENTS: POOLED DATA FROM TWO RHEUMATOID ARTHRITIS REGISTRIES IN CANADA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment as the first or an alternative option to biologic disease- modifying antirheumatic drugs (bDMARDs), including tumor necrosis factor inhibitors (TNFi). The similarity in retention of TNFi and TOFA was previously reported separately by the Ontario Best Practices Research Initiative (OBRI) and the Quebec cohort RHUMADATA®.Objectives:To increase the study power, we propose to evaluate the discontinuation rate (due to any reason) of TNFi compared to TOFA, using pooled data from both these registries.Methods:RA patients enrolled in the OBRI and RHUMADATA initiating their TOFA or TNFi between 1st June 2014 (TOFA approval date in Canada) and 31st Dec 2019 were included. Time to discontinuation was assessed using adjusted Kaplan-Meier (KM) survival and Cox regression models. To deal with confounding by indication, we estimated propensity scores for covariates with a standard difference greater than 0.1. Models were then adjusted using stratification and inverse probability of treatment weight (IPTW) methods. Multiple imputation (Imputation by Chained Equation method, N=20) was used to deal with missing data for covariates at treatment initiation.Results:A total of 1318 patients initiated TNFi (n=825) or TOFA (n=493) with mean (SD) disease duration of 8.9 (9.3) and 13.0 (10.1) years, respectively. In the TNFi group, 78.8% were female and mean age (SD) at treatment initiation was 57.6 (12.6) years. In the TOFA group, 84.6% were female and mean (SD) age at treatment initiation was 59.5 (11.5) years. The TNFi group was less likely to have prior biologic use (33.9%) than the TOFA group (66.9%). At treatment initiation, the mean (SD) CDAI was significantly (p<0.05) lower in the TNFi group [20.0 (11.7)] compared to the TOFA group [22.1(12.4)]. Physical function measured by HAQ-DI was also significantly lower (p<0.05) in the TNFi compared to the TOFA group (1.2 vs.1.3).Over a mean follow-up of 23.2 months, discontinuation was reported in 309 (37.5%) and 182 (36.9%) of all TNFi and TOFA patients, respectively. After adjusting for propensity score deciles across 20 imputed datasets, there was no significant difference in discontinuation between treatment groups (adjusted HRs: 0.96, 95% CI: 0.78-1.18; p=0.69). The results were similar for two propensity adjustment methods. Figure 1 shows IPTW adjusted KM survival curves comparing discontinuation rates in patients treated with TNFi and TOFA.Figure 1.Note: Propensity Score Weighted (IPTW) Survival Curves was performed using one imputed datasetConclusion:In this pooled real -world data study, we found that TNFi and TOFA retention is similar in patients with RA. In the next step we will analysis the data for specific reasons of dicontinutaion. We will also repeat analysis comparing discontinuation in the first users versus those after one or more biologic failure.Disclosure of Interests:Mohammad Movahedi: None declared, Denis Choquette Grant/research support from: Rhumadata® is supported by unrestricted grants from Abbvie Canada, Amgen Canada, Eli Lilly Canada, Novartis Canada, Pfizer Canada, Sandoz Canada and Sanofi Canada., Louis Coupal: None declared, Angela Cesta: None declared, Xiuying Li: None declared, Edward Keystone Grant/research support from: Amgen, Merck, Pfizer Pharmaceuticals, PuraPharm. Speaker Honoraria Agreements: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis. Consulting Agreements/Advisory Board Membership: AbbVie, Amgen, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Claire Bombardier Grant/research support from: OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN) and unrestricted grants from: Abbvie, Amgen, Aurora, Bristol-Meyers Squibb, Celgene, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sanofi, & UCB.Dr. Bombardier held a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care and a Pfizer Research Chair in Rheumatology
Collapse
|
23
|
Tatangelo M, Tomlinson G, Paterson JM, Keystone E, Bansback N, Bombardier C. Health care costs of rheumatoid arthritis: A longitudinal population study. PLoS One 2021; 16:e0251334. [PMID: 33956894 PMCID: PMC8101709 DOI: 10.1371/journal.pone.0251334] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/23/2021] [Indexed: 01/11/2023] Open
Abstract
Quantifying the contribution of rheumatoid arthritis to the acquisition of subsequent health care costs is an emerging focus of the rheumatologic community and payers of health care. Our objective was to determine the healthcare costs before and after diagnosis of rheumatoid arthritis (RA) from the public payer's perspective. The study design was a longitudinal observational administrative data-based cohort with RA cases from Ontario Canada (n = 104,933) and two control groups, matched 1:1 on year of cohort entry from 2001 to 2016. The first control group was matched on age, sex and calendar year of cohort entry (diagnosis year for those with RA); the second group added medical history to the match before RA diagnosis year. The main exposure was new onset RA. The secondary exposure was calendar year of RA diagnosis to compare attributable costs over the study observation window. Main outcomes were health care costs in 2015 Canadian dollars, overall and by cost category. We used attribution methods to classify costs into those associated with RA, those associated with comorbidities, and age/sex-related underlying costs. Health care costs associated with RA increased up to the year of diagnosis, where they reached $8,591: $4,142 in RA associated costs; $1,242 in RA comorbidity associated costs; and $3,207 in underlying costs. In the eighth-year post diagnosis, the RA costs declined to $2,567 while the RA comorbidity associated costs remained relatively constant at $1,142, and the underlying age/sex related cost increased to $4,426. RA patients had lower costs when diagnosed in later calendar years. Our results suggest a large proportion of disease related health care costs are a result of costs associated with RA comorbidities, which may appear many years before diagnosis.
Collapse
Affiliation(s)
- Mark Tatangelo
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - J Michael Paterson
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Nick Bansback
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Bombardier
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Cui K, Movahedi M, Bombardier C, Kuriya B. Cardiovascular risk factors are negatively associated with rheumatoid arthritis disease outcomes. Ther Adv Musculoskelet Dis 2021; 13:1759720X20981217. [PMID: 33643444 PMCID: PMC7890714 DOI: 10.1177/1759720x20981217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Aims: Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but the influence of CVD risk factors on RA outcomes is limited. We examined if CVD risk factors alone are associated with RA disease activity and disability. Methods: We performed a cross-sectional analysis of participants in the Ontario Best Practices Research Initiative, RA registry. Patients were categorized into mutually exclusive CVD categories: (1) No established CVD and no CVD risk factors; (2) CVD risk factors only including ⩾1 of hypertension, dyslipidemia, diabetes, or smoking; or (3) history of established CVD event. Multivariable regression analyses examined the effect of CVD status on Disease Activity Score 28 (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire Disability Index (HAQ-DI) scores at baseline. Results: Of 2033 patients, 50% had at least 1 CVD risk factor, even in the absence of established CVD. The presence of ⩾1 CVD risk factor was independently associated with higher CDAI [β coefficient 1.59, 95% confidence interval (CI) 0.29–2.90, p = 0.02], DAS28-ESR (β coefficient 0.20, 95% CI 0.06–0.34, p = 0.01) and HAQ-DI scores (β coefficient 0.15, 95% CI 0.08–0.22, p < 0.0001). The total number of CVD risk factors displayed a dose response, as >1 CVD risk factor was associated with higher disease activity and disability, compared with having one or no CVD risk factors. Conclusion: CVD risk factors alone, or in combination, are associated with higher disease activity and disability in RA. This emphasizes the importance of risk factor recognition and management, not only to prevent CVD, but also to improve potential RA outcomes.
Collapse
Affiliation(s)
- Kangping Cui
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Bindee Kuriya
- Division of Rheumatology, Sinai Health System, University of Toronto, 60 Murray Street, Room 2-008, Toronto, Ontario M5T 3L9, Canada
| |
Collapse
|
25
|
Pope JE, Rampakakis E, Movahedi M, Cesta A, Sampalis JS, Bombardier C. Time to remission in swollen joints is far faster than patient reported outcomes in rheumatoid arthritis: results from the Ontario Best Practices Research Initiative (OBRI). Rheumatology (Oxford) 2021; 60:717-727. [PMID: 32789456 DOI: 10.1093/rheumatology/keaa343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES RA patients are often not in remission due to patient global assessment of disease activity (PtGA) included in disease activity indices. The aim was to assess the lag of patient-reported outcomes (PROs) after remission measured by clinical disease activity index (CDAI) or swollen joint count (SJC28). METHODS RA patients enrolled in the Ontario Best Practices Research Initiative registry not in low disease state at baseline with at ≥6 months of follow-up, were included. Low disease state was defined as CDAI ≤ 10, SJC28 ≤ 2, PtGA ≤ 2cm, pain score ≤ 2cm, or fatigue ≤ 2cm. Remission included CDAI ≤ 2.8, SJC28 ≤ 1, PtGA ≤ 1cm, pain score ≤ 1cm, or fatigue ≤ 1cm. Time to first low disease state/remission based on each definition was calculated overall and stratified by early vs established RA. RESULTS A total of 986 patients were included (age 57.4 (12.9), disease duration 8.3 (9.9) years, 80% women). The median (95% CI) time in months to CDAI ≤ 10 was 12.4 (11.4, 13.6), SJC28 ≤ 2 was 9 (8.2, 10), PtGA ≤ 2cm was 18.9 (16.1, 22), pain ≤ 2cm was 24.5 (19.4, 30.5), and fatigue ≤ 2cm was 30.4 (24.8, 31.7). For remission, the median (95% CI) time in months to CDAI ≤ 2.8 was 46.5 (42, 54.1), SJC28 ≤ 1 was 12.5 (11.4, 13.4), PtGA ≤ 1cm was 39.6 (34.6, 44.8), pain ≤ 1cm was 54.7 (43.6, 57.5) and fatigue ≤ 1cm was 42.6 (36.8, 48). Time to achieving low disease state and remission was generally significantly shorter in early RA compared with established RA with the exception of fatigue. CONCLUSION Time to achieving low disease state or remission based on PROs was considerably longer compared with swollen joint count. Treating to a composite target in RA could lead to inappropriate changes in DMARDs.
Collapse
Affiliation(s)
- Janet E Pope
- Divisions of Rheumatology, Epidemiology, and Biostatistics, Department of Medicine, Western University, London, ON, Canada
| | | | - Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - John S Sampalis
- Medical Affairs, JSS Medical Research, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Medicine, (DOM) and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
26
|
Hepworth E, Movahedi M, Rampakakis E, Mirza R, Lau A, Cesta A, Pope J, Sampalis JS, Bombardier C. Changes in Market Share of Biologic and Targeted Synthetic Disease-Modifying Anti-Rheumatic Drugs for Treatment of Rheumatoid Arthritis: Results from the Ontario Best-Practice Research Initiative Database. Curr Rheumatol Rev 2020; 17:349-359. [PMID: 33308132 DOI: 10.2174/1573397116666201211130337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE For patients with Rheumatoid Arthritis (RA) who do not achieve adequate clinical response with combined conventional synthetic disease-modifying anti-rheumatic drugs (cs- DMARDs), initiation of advanced therapies such as biologic DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) is recommended. Tumour necrosis factor inhibitors (TNFi) are the oldest and most commonly used subgroup of advanced therapies. In the last decade, new non-TNFi advanced therapy options have become available. We described the relative use of TNFi vs. non-TNFi in Ontario-based practices from 2008-2017. METHODS Adult patients with RA enrolled in the Ontario Best Practices Research Initiative (OBRI) database who started bDMARDs or tsDMARDs anytime during or within 30 days prior to enrollment were included. The proportion of patients treated with TNFi vs. non-TNFi agents between 2008 and 2017 was described for all patients and those initiating their first bDMARD/tsDMARD. All TNFi therapies were included. Non-TNFi included Abatacept, Rituximab, Tocilizumab, and Tofacitinib. RESULTS A total of 1,057 patients were included, of whom 72.0% were bDMARD/tsDMARD naïve. In 2008, the relative non-TNFi use was 5.4% in all patients while it was 0% in bDMARD/ts- DMARD-naïve patients. In 2017, the proportion of patients using non-TNFi increased to 33.8% among all patients and 33.3% in bDMARD/tsDMARD-naïve patients. CONCLUSION This descriptive analysis of data from the OBRI cohort reveals that TNFi are still used in the majority of cases; however, there has been an increase in the use of non-TNFi therapies both overall and as first-line advanced therapy. This trend towards non-TNFi therapies as first-line advanced therapy may be partially explained by the shift in guideline recommendations from TNFi as first-line to any of the advanced therapeutics.
Collapse
Affiliation(s)
- Elliot Hepworth
- Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammad Movahedi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Reza Mirza
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arthur Lau
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Janet Pope
- Divisions of Rheumatology, Epidemiology and Biostatistics, Department of Medicine, Western University, London, ON, Canada
| | | | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
27
|
Tatangelo MR, Tomlinson G, Keystone E, Paterson JM, Bansback N, Bombardier C. Comorbidities Before and After the Diagnosis of Rheumatoid Arthritis: A Matched Longitudinal Study. ACR Open Rheumatol 2020; 2:648-656. [PMID: 33104286 PMCID: PMC7672304 DOI: 10.1002/acr2.11182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the contribution of rheumatoid arthritis (RA) to conditions and medical events. A secondary objective is to quantify this association before and after the introduction of biologic medications. METHODS All data were collected as health administrative data in Ontario, Canada. Patients with RA (n = 136 678) matched 1:1 to a pool of possible controls without RA from 1995 to 2016. The study was a retrospective longitudinal observational administrative data-based cohort study with cases (RA) and controls (two non-RA comparator groups). The main exposure was new-onset RA identified by a validated diagnosis algorithm. The secondary exposure was the calendar year, which provided a natural experiment to compare years in which biologics were unavailable (pre-2001) to increasing utilization over time. The main outcomes were counts of 27 Johns Hopkins Expanded Diagnostic Cluster Comorbid Conditions. Outcomes were reported as counts and percentage differences between cases and matched controls. RESULTS Patients experienced increases in conditions and medical events up to 5 years before RA disease incidence-4.9 conditions per patient-year compared with 4.6 conditions per patient-year in matched controls. Comorbidities increased to 8.7 conditions per patient-year in the year of RA incidence but were lower in the years after diagnosis-6.9 conditions per patient-year at 5 years postdiagnosis. CONCLUSION This study reframes the clinical manifestations of RA with detailed data on the marginal contribution of RA to conditions and medical events. These results show that a large portion of disease burden is due to the indirect effects of RA.
Collapse
Affiliation(s)
- Mark R. Tatangelo
- University of Toronto and the Toronto General Research InstituteTorontoOntarioCanada
| | - George Tomlinson
- University of Toronto and the Toronto General Research InstituteTorontoOntarioCanada
| | - Edward Keystone
- University of Toronto, Toronto, Ontario, Canada and Mount Sinai HospitalTorontoOntarioCanada
| | - J. Michael Paterson
- University of Toronto, Toronto, Ontario, Canada and ICESTorontoOntarioCanada
| | - Nick Bansback
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Claire Bombardier
- University of Toronto and the Toronto General Research InstituteTorontoOntarioCanada
| |
Collapse
|
28
|
Movahedi M, Hepworth E, Mirza R, Cesta A, Larche M, Bombardier C. Discontinuation of biologic therapy due to lack/loss of response and adverse events is similar between TNFi and non-TNFi class: Results from a real-world rheumatoid arthritis cohort. Semin Arthritis Rheum 2020; 50:915-922. [PMID: 32911288 DOI: 10.1016/j.semarthrit.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Time to discontinuation of biologic therapy may be related to mechanism of action. We aimed to compare discontinuation of tumor necrosis factor inhibitors (TNFi) versus non-TNFi in an observational rheumatoid arthritis cohort. METHODS Patients enrolled in the Ontario Best Practices Research Initiative (OBRI) starting biologic agents on or after 1st January 2010 were included. Time to discontinuation due to (1) any reason, (2) any of lack/loss of response, adverse events (AEs), physician, or patient decision, (3) lack/loss of response, and (4) AEs were assessed using Kaplan-Meier survival and Cox proportional hazards regression analysis. RESULTS A total of 932 patients were included of whom 174 (18.7%) received non-TNFi and 758 (81.3%) received TNFi. Over a median follow-up of 1.7 years, discontinuation was reported for 416 (44.6%) due to any reason, 367 (39.4%) due to any of lack/loss of response, AEs, physician, or patient decision, 192 (20.6%) due to lack/loss of response, and 102 (10.9%) due to AEs. After adjusting for propensity score, there was no significant difference in discontinuation between the two classes due to any reason [HR 1.14 (0.90-1.46), p = 0.28], lack/loss of response [HR: 1.01 (0.70-1.47), p = 0.95], and AEs [HR: 1.06 (0.64-1.73), p = 0.83]. Similar results were found in biologic naïve patients. CONCLUSIONS This analysis demonstrates that discontinuation of therapy is similar in patients started on TNFi and non-TNFi therapies. There was also no significant difference in stopping due to lack/loss of response or AEs, suggesting that these reasons should not drive the selection of one treatment over another.
Collapse
Affiliation(s)
- Mohammad Movahedi
- Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
| | - Elliot Hepworth
- Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Reza Mirza
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Cesta
- Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Maggie Larche
- Divisions of Rheumatology and Clinical Immunology and Allergy, Departments of Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Claire Bombardier
- Ontario Best Practices Research Initiative, Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine (DOM) and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.
| |
Collapse
|
29
|
Movahedi M, Cesta A, LI X, Bombardier C. FRI0045 DISEASE ACTIVITY TRAJECTORIES FOR EARLY AND ESTABLISHED RHEUMATOID ARTHRITIS: DATA FROM THE OBRI REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Description of disease activity status in patients with rheumatoid arthritis (RA) at fixed points in time modelled as continuous (e.g. number of swollen joints counts), dichotomous variable (e.g. remission or low disease status using composite measures) do not reflect the patient’s disease course in chronic and relapsing RA.Objectives:We proposed to describe the longitudinal disease activity trajectories for patients with early and established RA over two years’ follow-up in routine clinical care.Methods:RA patients enrolled in the Ontario Best Practices Research Initiative (OBRI) with available DAS28-ESR over two years of follow-up were included. Using a latent growth curve modelling (LCGM), subgroups of patients following distinct pattern of DAS28-ESR change over time were identified. Fit statistics and model selection was based on Bayesian information criterion (BIC).Results:A total of 1273 patients were included, 454 (36%) with early RA and 819 (64%) with established RA. At baseline, patients with early RA were significantly younger (57.3 vs. 59.1 years) and with higher DAS28-ESR (4.6 vs. 4.3), and were less likely to have an erosion (25.0% vs. 59.7%), to be RF-positive (70.3% vs. 76.8%), and to use biologic DMARDs (7.0% vs. 29.2%).In patients with early RA (Figure 1A), three subgroups of patients were identified by LCGM with a better fit (BIC: -3070.84). Almost 88% patients with moderate disease activity reached remission (group 1: 48.4%) or low disease status (group 2: 39.3%) after two years, while 12% of patients with high disease profile remained in a moderate state (group 3).Figure 1.Observed and fitted trajectories from the latent growth curve analysis in patients with early and established RA.In patients with established RA (Figure 1B), seven subgroup of patients were identified by LCGM with a better fit (BIC: -5378.13). After two years’ follow-up, 37.5% of patients in remission or low disease state at baseline remained or reached to remission (group 1 and 2, respectively). Two groups of patients with high disease activity at baseline had an improvment after two years (17.3% reached remission and 9.3% reached moderate state; group 5 and 7, respectively). 16.5% of patients with high disease activity at baseline remained in high disease status after two years (group 4 and 6). 19.4% of patients with moderate activity at baseline remained in a moderate state after two years (group 3).Conclusion:Disease course is different between early and established RA. While 70% of early RA patients with moderate or high disease profiles reached remission, only 17% of established patients with high disease activity achieved remission after two years of follow-up. These findings suggest the potential effects of receiving early treatment and health care. The impact of sociodemographic, clinical and medication profile on disease course will be examined as future work for this study.Disclosure of Interests:Mohammad Movahedi Consultant of: Allergan, Angela Cesta: None declared, Xiuying Li: None declared, Claire Bombardier Grant/research support from: Dr Bombardier reports sources of funding for Ontario Best Practice Research Initiative Research grants from Abbvie, Janssen, Amgen, Medexus, Merck, Pfizer, and Novartis outside of the submitted work. Consulting Agreements: Abbvie, Covance, Janssen, Merck, Pfizer, Sanofi and Novartis outside of the submitted work. Advisory Board Membership: Hospira, Sandoz, Merck, Pfizer and Novartis outside of the submitted work.
Collapse
|
30
|
Keystone E, Movahedi M, Cesta A, Bombardier C, Sampalis J, Rampakakis E. AB0211 DIFFERENTIAL INFLUENCE OF CDAI COMPONENTS BASED ON DISEASE STATE IN RHEUMATOID ARTHRITIS PATIENTS: REAL-WORLD RESULTS FROM THE ONTARIO BEST PRACTICES RESEARCH INITIATIVE (OBRI). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Treat-to-target recommendations for rheumatoid arthritis (RA) dictate that remission or low disease activity should be aimed. Although numerous composite indices are available, the clinical disease activity index (CDAI) is commonly used in routine clinical care due to its simplicity and non-reliance on acute phase reactants.Objectives:The purpose of this analysis was to evaluate the CDAI properties both cross-sectionally and longitudinally in a cohort of RA patients followed in Canadian routine care.Methods:RA patients enrolled in the Ontario Best Practices Research Initiative (OBRI), with available follow-up for ≥6 months and data on CDAI, disease activity score based on 28 joints (DAS28), health assessment questionnaire (HAQ), and ACR/EULAR Boolean remission were included. For both the CDAI score and its change from baseline to 6 months, construct validity was assessed with principal component analysis, internal consistency with the Cronbach’s alpha coefficient (α), correlational validity with the Spearman’s rho coefficient, agreement in disease state classification with percent concordant pairs and the kappa statistic. Stratified analysis by presence of CDAI low disease activity (LDA) or remission was performed.Results:1,582 patients met the inclusion criteria. Principal component analysis showed that CDAI could be reduced to a single component when CDAI is >10 with SJC28 accounting for most variance in score and patient global assessment (PtGA) the least; whereas, when CDAI is ≤10, two distinct components were identified, the first comprising PtGA and physician global assessment (PhGA) and the second SJC28 and TJC28. In terms of internal consistency, high levels were observed for both CDAI at baseline (α=0.83) and its change from baseline to 6 months (α=0.81); however, the consistency between CDAI components was very low when CDAI is ≤10 (α=0.23).Overall, a strong positive correlation was observed between CDAI and DAS28 (rho=0.86) and their changes (rho=0.87) while its correlation with HAQ was weak. When stratifying by CDAI levels, the correlation of CDAI with DAS28 was moderate when CDAI is ≤10 and very weak when CDAI is ≤2.8. Similarly, agreement in the classification of LDA between CDAI and DAS28 or HAQ was fair to moderate, and agreement in classification of remission was poor to fair.Conclusion:CDAI and DAS28 correlate well when disease activity is moderate or high and poorly in LDA or remission. PtGA had a stronger influence on CDAI at LDA or remission state compared to moderate or high disease state. Thus, careful interpretation of PtGA is necessary particularly in patients who are identified as CDAI non-remitters.Disclosure of Interests:Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Mohammad Movahedi Consultant of: Allergan, Angela Cesta: None declared, Claire Bombardier Grant/research support from: Dr Bombardier reports sources of funding for Ontario Best Practice Research Initiative Research grants from Abbvie, Janssen, Amgen, Medexus, Merck, Pfizer, and Novartis outside of the submitted work. Consulting Agreements: Abbvie, Covance, Janssen, Merck, Pfizer, Sanofi and Novartis outside of the submitted work. Advisory Board Membership: Hospira, Sandoz, Merck, Pfizer and Novartis outside of the submitted work., John Sampalis: None declared, Emmanouil Rampakakis: None declared
Collapse
|
31
|
Pope J, Movahedi M, Rampakakis E, Cesta A, Sampalis J, Bombardier C. SAT0049 DIFFERENCES BETWEEN EARLY AND ESTABLISHED RHEUMATOID ARTHRITIS IN TIME TO ACHIEVING CDAI BUT NOT FATIGUE LOW DISEASE ACTIVITY AND REMISSION: DATA FROM THE OBRI REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Previous studies have shown that early diagnosis and treatment of rheumatoid arthritis (RA) is important for achieving comprehensive disease control and have identified established disease as an independent predictor of worse clinical outcomes. However, it is not clear whether these differences are driven by patient-reported or objective outcome measures.Objectives:The aim of this analysis was to compare the time to achieving low disease activity (LDA) and remission based on both objective and patient-reported outcomes in people with early vs. established RA followed in routine clinical care.Methods:RA patients enrolled in the Ontario Best Practices Research Initiative (OBRI) registry that were not in a low disease state at baseline based on the CDAI, SJC28, PtGA, pain and fatigue criteria below, and had at least six months of follow-up, were included in the analysis. LDA was defined as CDAI≤10, SJC28≤2, TJC28≤2, PtGA≤2cm, pain≤2cm, fatigue≤2cm, and MDGA≤2cm; remission was defined as CDAI≤2.8, SJC28≤1, TJC28≤1, PtGA≤1cm, pain≤1cm, fatigue≤1cm, and MDGA≤1cm. Between group (early vs. established) differences in time to first LDA/remission were assessed with Kaplan-Meier survival analysis and the log-rank test.Results:A total of 986 patients were included, 347 (35%) with early RA and 639 (65%) with established RA. At baseline, patients with early RA were significantly younger (55.8 vs. 58.3 years) and were less likely to have a comorbidity (94.5% vs. 97.5%) or an erosion (26.7% vs. 62.6%), be RF-positive (65.6% vs. 74.2%), use bDMARDs (7.5% vs. 26.6%), and be non-smokers (38.9% vs. 47.3%).Time to achieving LDA based on CDAI (HR [95%CI]: (1.23 [1.07,1.43]), SJC28 (1.32 [1.15,1.51]), TJC28 (1.18 [1.02,1.36]), MDGA (1.28 [1.10,1.49]), PtGA (1.23 [1.05,1.44]), and pain (1.29 [1.09,1.52]) were significantly shorter in early RA compared to established RA. Similarly, time to achieving remission based on CDAI (HR [95%CI]: (1.50 [1.22,1.84]), SJC28 (1.35 [1.17,1.55]), MDGA (1.25 [1.06,1.47]), PtGA (1.22 [1.02,1.47]), and pain (1.37 [1.14,1.65]) were significantly shorter in early RA. However, no differences were observed in time to remission based on TJC28 (1.12 [0.96,1.31]) and either LDA or remission based on fatigue (LDA (1.10 [0.94,1.30]); remission (1.09 [0.92,1.31]).Adjustment for age, gender, presence of comorbidities, and baseline scores did not alter the results.Conclusion:Time to achieving low disease state or remission based on various objective and patient-reported measures is significantly shorter in early compared to established RA with the exception of fatigue.Disclosure of Interests:Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Mohammad Movahedi Consultant of: Allergan, Emmanouil Rampakakis: None declared, Angela Cesta: None declared, John Sampalis: None declared, Claire Bombardier Grant/research support from: Dr Bombardier reports sources of funding for Ontario Best Practice Research Initiative Research grants from Abbvie, Janssen, Amgen, Medexus, Merck, Pfizer, and Novartis outside of the submitted work. Consulting Agreements: Abbvie, Covance, Janssen, Merck, Pfizer, Sanofi and Novartis outside of the submitted work. Advisory Board Membership: Hospira, Sandoz, Merck, Pfizer and Novartis outside of the submitted work.
Collapse
|
32
|
Movahedi M, Cesta A, LI X, Keystone E, Bombardier C. OP0211 TIME TO DISCONTINUATION OF TOFACITINIB AND TNF INHIBITORS IN RHEUMATOID ARTHRITIS PATIENTS WITH AND WITHOUT METHOTREXATE: DATA FROM A RHEUMATOID ARTHRITIS COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tofacitinib (TOFA) is an oral, small molecule drug used for rheumatoid arthritis (RA) treatment and is prescribed alone or with methotrexate (MTX). Tofa can be used as an alternative to biologic disease modifying antirheumatic drugs (bDMARDs) including tumor necrosis factor inhibitors (TNFi).Objectives:We aimed to evaluate the discontinuation rate of this drug, with and without concurrent MTX in comparison with TNFi, in patients with RA in the Ontario Best Practices Research Initiative (OBRI).Methods:RA patients enrolled in the OBRI initiating their TOFA or TNFi (adalimumab, certolizumab, etancercept, golimumab, and infliximab) within 30 days prior to or any time after enrolment between 1stJune 2014 (TOFA approval date in Canada) and 31stDec 2018 were included. Time to discontinuation (due to any reason) were assessed using Kaplan-Meier survival (adjusted for propensity score using inverse probability of treatment weight) to compare patients with and without MTX use at initiation of TOFA or TNFi.Results:A total of 565 patients initiated TOFA (n=208) or TNFi (n=357). Of those, 106 (51%) and 222 (62%) were treated with MTX in the TOFA and TNFi group, respectively and mean (SD) disease duration were 13.1 (9.4) and 9.5 (9.4) years. In the TOFA group, 86% were female and mean (SD) age at treatment initation was 60.4 (10.6) years. In the TNFi group 82% were female and mean age (SD) at treatment initation was 57.0 (12.6) years. The TOFA group was more likely to have prior biologic use (61.5%) compared with the TNFi group (31%). At treatment initiation, the mean (SD) clinical disease activcity index was 24.8 (12.1) in the TOFA group and 21.8 (12.0) in the TNFi group.Over a mean of 17.3 month follow-up, discontinuation was reported in 75 (36%) and 103 (29%) of all TOFA and TNFi patients, respectively. After adjusting for propensity score, patients treated with TNFi and MTX remained on treatment longer than those treated without MTX (Logrank p=0.002) while there was no significant difference in TOFA discontinuation in patients with and without MTX (Logrank p=0.31).Conclusion:In this real world data study, we found that TOFA retention is similar in patients with and without MTX, while patients treated with TNFi and MTX remained on treatment longer than those treated without MTX. Merging data with other RA registries in Canada is proposed to increase study power and to provide more robust results.Disclosure of Interests:Mohammad Movahedi Consultant of: Allergan, Angela Cesta: None declared, Xiuying Li: None declared, Edward Keystone Grant/research support from: AbbVie; Amgen; Gilead Sciences, Inc; Lilly Pharmaceuticals; Merck; Pfizer Pharmaceuticals; PuraPharm; Sanofi, Consultant of: AbbVie; Amgen; AstraZeneca Pharma; Bristol-Myers Squibb Company; Celltrion; F. Hoffman-La Roche Ltd.; Genentech, Inc; Gilead Sciences, Inc.; Janssen, Inc; Lilly Pharmaceuticals; Merck; Myriad Autoimmune; Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis., Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celltrion; F. Hoffman-La Roche Ltd, Janssen, Inc; Merck; Pfizer Pharmaceuticals; Sanofi-Genzyme; UCB, Claire Bombardier Grant/research support from: Dr Bombardier reports sources of funding for Ontario Best Practice Research Initiative Research grants from Abbvie, Janssen, Amgen, Medexus, Merck, Pfizer, and Novartis outside of the submitted work. Consulting Agreements: Abbvie, Covance, Janssen, Merck, Pfizer, Sanofi and Novartis outside of the submitted work. Advisory Board Membership: Hospira, Sandoz, Merck, Pfizer and Novartis outside of the submitted work.
Collapse
|
33
|
Fullerton LM, Brooks S, Sweezie R, Ahluwalia V, Bombardier C, Gagliardi AR. Patient, Rheumatologist and Therapist Perspectives on the Implementation of an Allied Health Rheumatology Triage (AHRT) Initiative in Ontario Rheumatology Clinics. Pragmat Obs Res 2020; 11:1-12. [PMID: 32095089 PMCID: PMC6995293 DOI: 10.2147/por.s213966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The objective of this qualitative study was to explore patient, rheumatologist, and extended role practitioner (ERP) perspectives on the integration of an allied health rheumatology triage (AHRT) intervention in Ontario rheumatology clinics. Triage is the process of identifying the urgency of a patient's condition to ensure they receive specialist care within an appropriate length of time. This research explores the clinical/logistical impact of triage by occupational and physical therapists with advanced arthritis training (ERPs), including facilitators and barriers of success, and recommendations for future application. Participants and Methods Semi-structured telephone interviews were held with participating rheumatologists, ERPs, and a sample of patients from each clinical site (4 community, 3 hospital) in five Ontario cities. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using basic qualitative description. Two independent researchers compared coding and achieved consensus. Results Patients (n=10), rheumatologists (n=6), and ERPs (n=5) participated in the study and reported reduced wait-times to rheumatology care, diagnosis, and treatment for those with inflammatory arthritis (IA). Rheumatologists and ERPs perceived that the intervention improved clinical efficiency and quality of care. Patients reported high satisfaction with ERP assessments, valuing early joint examination/laboratory tests, urgent referral if needed, and the provision of information, support, and management strategies. Facilitators of success included: supportive clinical staff, regular communication and collaboration between rheumatologist and ERP, and sufficient clinical space. Recommendations included extending ERP roles to include stable patient follow-up, and ERP care between scheduled rheumatology appointments. Conclusion Findings support the integration of ERPs in a triage role in the community and hospital-based rheumatology models of care. Future research is needed to explore the impact of utilizing ERPs for stable patient follow-up in rheumatology settings.
Collapse
Affiliation(s)
- Laura M Fullerton
- Ontario Best Practices Research Initiative, Toronto General Research Institute, Toronto, ON, Canada
| | - Sydney Brooks
- Ontario Division, Arthritis Society, Toronto, ON, Canada
| | - Raquel Sweezie
- Ontario Division, Arthritis Society, Toronto, ON, Canada
| | - Vandana Ahluwalia
- Department of Rheumatology, William Osler Health System, Brampton, ON, Canada
| | - Claire Bombardier
- Toronto General Research Institute, University of Toronto, Toronto, ON, Canada
| | - Anna R Gagliardi
- Toronto General Research Institute, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
34
|
Hazlewood GS, Pokharel G, Deardon R, Marshall DA, Bombardier C, Tomlinson G, Ma C, Seow CH, Panaccione R, Kaplan GG. Patient preferences for maintenance therapy in Crohn's disease: A discrete-choice experiment. PLoS One 2020; 15:e0227635. [PMID: 31945089 PMCID: PMC6964885 DOI: 10.1371/journal.pone.0227635] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/24/2019] [Indexed: 12/30/2022] Open
Abstract
Objective To quantify patient preferences for maintenance therapy of Crohn’s disease and understand the impact on treatment selection. Methods We conducted a discrete-choice experiment in patients with Crohn’s disease (n = 155) to measure the importance of attributes relevant to choosing between different medical therapies for maintenance of Crohn’s disease. The attributes included efficacy and withdrawals due to adverse events, as well as dosing and other rare risks of treatment. From the discrete-choice experiment we estimated the part-worth (importance) of each attribute level, and explored preference heterogeneity through latent class analysis. We then used the part-worths to apply weights across each outcome from a prior network meta-analysis to estimate patients’ preferred treatment in pairwise comparisons and for the overall group of treatments. Results The discrete-choice experiment revealed that maintaining remission was the most important attribute. Patients would accept a rare risk of infection or cancer for a 14% absolute increased chance of remission. Latent class analysis demonstrated that 45% of the cohort was risk averse, either to adverse events or requiring a course of prednisone. When these preferences were used in modelling studies to compare pairs of treatments, there was a ≥ 78% probability that all biologic treatments were preferred to azathioprine and methotrexate, based on the balance of benefits and harms. When comparing all treatments, adalimumab was preferred by 53% of patients, who were motivated by efficacy, and vedolizumab was preferred by 30% who were driven by the preference to avoid risks. However, amongst biologic treatment options, there was considerable uncertainty regarding the preferred treatment at the individual patient level. Conclusion Patients with Crohn’s disease from our population were, on average, focused on the benefits of treatment, supporting intensive treatment approaches aimed at maintaining remission. Important preference heterogeneity was identified, however, highlighting the importance of shared decision making when selecting treatments.
Collapse
Affiliation(s)
- Glen S. Hazlewood
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (GK); (GH)
| | - Gyanendra Pokharel
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Robert Deardon
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
- Department of Production of Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A. Marshall
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Bombardier
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Ma
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H. Seow
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G. Kaplan
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (GK); (GH)
| |
Collapse
|
35
|
Díaz S, Zhao J, Cronin S, Jaglal S, Bombardier C, Furlan AD. Changes in Opioid Prescribing Behaviors among Family Physicians Who Participated in a Weekly Tele-Mentoring Program. J Clin Med 2019; 9:jcm9010014. [PMID: 31861584 PMCID: PMC7019354 DOI: 10.3390/jcm9010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022] Open
Abstract
A weekly tele-mentoring program was implemented in Ontario to help address the growing opioid crisis through teaching and mentoring family physicians on the management of chronic pain and opioid prescribing. This study assessed opioid prescribing behaviours among family physicians who attended the tele-mentoring program compared to two groups of Ontario family physicians who did not attend the program. We conducted a retrospective cohort study with two control groups: a matched cohort, and a random sample of 3000 family physicians in Ontario. Each physician was followed from one year before the program, which is the index date, and one year after. We examined the number and proportion of patients on any opioid, on high dose opioids, and the average daily morphine equivalent doses prescribed to each patient. We included 24 physicians who participated in the program (2760 patients), 96 matched physicians (11,117 patients) and 3000 random family doctors (374,174 patients). We found that, at baseline, the tele-mentoring group had similar number of patients on any opioid, but more patients on high dose opioids than both control groups. There was no change in the number of patients on any opioid before and after the index date, but there was a significant reduction in high-dose opioid prescriptions in the extension for community healthcare outcomes (ECHO) group, compared to a non-significant increase in the matched cohort, and a non-significant reduction in the Ontario group during the same comparable periods. Participation in the program was associated with a greater reduction in high-dose opioid prescribing.
Collapse
Affiliation(s)
- Santana Díaz
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
| | - Jane Zhao
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G1L7, Canada
| | - Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON M5S, Canada
| | - Claire Bombardier
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S, Canada
- Mount Sinai Hospital, Toronto, ON M5G1X5, Canada
- Institute for Work & Health, Toronto, ON M5G2E9, Canada
| | - Andrea D. Furlan
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G1L7, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S, Canada
- Institute for Work & Health, Toronto, ON M5G2E9, Canada
- Correspondence:
| |
Collapse
|
36
|
Tatangelo M, Tomlinson G, Paterson JM, Ahluwalia V, Kopp A, Gomes T, Bansback N, Bombardier C. Association of Patient, Prescriber, and Region With the Initiation of First Prescription of Biologic Disease-Modifying Antirheumatic Drug Among Older Patients With Rheumatoid Arthritis and Identical Health Insurance Coverage. JAMA Netw Open 2019; 2:e1917053. [PMID: 31808927 PMCID: PMC6902765 DOI: 10.1001/jamanetworkopen.2019.17053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Prescribing the first biologic treatment for rheumatoid arthritis (RA) is an important decision for patients, their physicians, and payers, with considerable costs and clinical implications. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) have known effectiveness and safety profiles and are less expensive; therefore, determining the variables contributing to csDMARD treatment duration is an essential question for patients, physicians, and payers. OBJECTIVES To describe access to the first biologic DMARD prescription in a population of patients with RA and identical comprehensive health insurance coverage in Ontario, Canada, and to explore the associations of patient, prescriber, and geographic region with differences in time to first biologic prescription. DESIGN, SETTING, AND PARTICIPANTS This cohort study of incident patients with RA used administrative data with surveillance and patient-level data collected at yearly intervals. A total of 17 672 patients were included in the study; they were residents of Ontario, Canada, had an incident RA diagnosis at age 67 or older between 2002 and 2015, and received at least 1 csDMARD. Data were analyzed in November 2017. EXPOSURE Patient variables were age, sex, disease duration, socioeconomic status, distance to care, and supply of care in the patient's area of residence. Prescriber covariates were year of graduation, specialty of practice, and supply of rheumatologic care in the patient's geographic region. MAIN OUTCOMES AND MEASURES Time from first csDMARD prescription to receipt of first biologic medication. RESULTS Of 17 672 patients, 11 598 (65.6%) were women, and the mean (SD) age was 75.2 (5.8) years. Characteristics associated with longer time to receipt of a biologic prescription were older age (HR for every 5-year increase, 0.66; 95% CI, 0.62-0.71; P < .001), male sex (HR, 0.76; 95% CI, 0.66-0.89; P < .001), and distance to the nearest rheumatologist (HR per 10-km increase, 0.99; 95% CI, 0.98-0.99; P < .001). Prescribers were primarily rheumatologists (151 of 214 [70.6%]) and primary care physicians (26 of 214 [12.1%]). After adjusting for the number of patients eligible to receive biologic DMARDs, rheumatologists' preferences (ie, yearly prescription rates) for using biologic DMARDs increased over time, from 1.7% in 2001 to 4.9% in 2015. After adjusting for calendar year and patient-, prescriber-, and region-level characteristics, substantial variation between prescribers in rates of prescribing a first biologic DMARD were found (65% variance). CONCLUSIONS AND RELEVANCE This study found variation in time to receipt of first biologic DMARD after prescription of first csDMARD in a population with RA after adjustment for individual-level patient, prescriber, and geographic area covariates, despite identical universal health insurance coverage.
Collapse
Affiliation(s)
- Mark Tatangelo
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - J. Michael Paterson
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | - Tara Gomes
- University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- St Michael’s Hospital, Toronto, Ontario, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Bombardier
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Li G, Chen M, Li X, Cesta A, Lau A, Thabane L, Adachi JD, Tian J, Bombardier C. Frailty and risk of osteoporotic fractures in patients with rheumatoid arthritis: Data from the Ontario Best Practices Research Initiative. Bone 2019; 127:129-134. [PMID: 31185289 DOI: 10.1016/j.bone.2019.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
The evidence assessing the relationship between frailty and risk of adverse health outcomes in patients with rheumatoid arthritis (RA) remains limited and sparse in the literature. Data from the Ontario Best Practices Research Initiative (OBRI), a clinical registry of patients with RA, were used to explore the relationship between frailty and fracture risk in patients with RA. Patients were referred to OBRI by their participating rheumatologist, and contacted by OBRI trained interviewers. Primary outcome was time to first incident osteoporotic fractures during follow-up that led to a hospitalization or emergency room visit. Frailty was measured by a Rockwood-type frailty index (FI) of deficit accumulation that consisted of 32 health-related deficits. To quantify the relationship between frailty and risk of fracture, we used Cox proportional hazards models with hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) reported. We included 2923 patients (mean age 57.7 standard deviation [SD]: 12.7; 78% female,) for analyses. During a mean follow-up of 3.7 years, there were 125 (4.3%) incident fractures reported. The FI was significantly higher in patients with a fracture compared to controls (0.24 vs. 0.20, p = 0.02). The FI was found to be significantly related to increased risk of fracture in the fully-adjusted models, with a HR of 1.04 (95% CI: 1.02-1.06, p < 0.001) and 1.58 (95% CI: 1.32-1.89, p < 0.001) for per-0.01 and per-SD increase in the FI respectively. In summary, our study demonstrates that higher frailty status is significantly related to increased risk of osteoporotic fractures in patients with RA. Quantifying the frailty status as a research tool may aid in fracture risk assessment, management and decision-making in RA.
Collapse
Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
| | - Maoshui Chen
- Department of Orthopedics No. 2 (Spinal Surgery), Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
| | - Xiuying Li
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Arthur Lau
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Jonathan D Adachi
- Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Junzhang Tian
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Claire Bombardier
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
38
|
Keystone EC, Rampakakis E, Movahedi M, Cesta A, Stutz M, Sampalis JS, Nantel F, Maslova K, Bombardier C. Toward Defining Primary and Secondary Nonresponse in Rheumatoid Arthritis Patients Treated with Anti-TNF: Results from the BioTRAC and OBRI Registries. J Rheumatol 2019; 47:510-517. [PMID: 31263067 DOI: 10.3899/jrheum.190102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although most patients with rheumatoid arthritis (RA) respond to anti-tumor necrosis factor (anti-TNF) treatment, some present with initial nonresponse (1ry nonresponse) or lose initial responsiveness (2ry nonresponse). We compared the rate of real-world "nonresponse" to first anti-TNF as reported by treating physicians to the nonresponse rate per accepted definitions and recommended treat-to-target strategies. METHODS Patients were included from the Biologic Treatment Registry Across Canada (BioTRAC) and Ontario Best Practices Research Initiative (OBRI) registries who were taking their first anti-TNF, with ≥ 1 followup visit. Posthoc reclassification of physician-reported nonresponse was based on prior achievement of 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR) low disease activity (LDA), Clinical Disease Activity Index (CDAI) LDA, or good/moderate European League Against Rheumatism (EULAR) response, and actual time of physician-reported nonresponse. RESULTS Among 736 BioTRAC and 640 OBRI patients, 13.7% and 18%, respectively, discontinued their anti-TNF because of physician-reported nonresponse. Based on reclassification using disease activity, 65.6% (BioTRAC) and 87.2% (OBRI) of 1ry nonresponders did not achieve DAS28-ESR LDA, 65.6%/90.7% CDAI LDA, and 46.9%/61.5% good/moderate EULAR response. Among 2ry nonresponders, 50.7%/47.8% did not achieve DAS28-ESR LDA, 37.7%/52.9% CDAI LDA, and 15.9%/19.6% good/moderate EULAR response before treatment discontinuation. Regarding actual time of nonresponse, 18.8% of BioTRAC and 60.8% of OBRI 1ry nonresponders discontinued at ≤ 6 months. In both registries, a high proportion of 2ry nonresponders discontinued their anti-TNF after 12 months (87.0% BioTRAC, 60.9% OBRI). CONCLUSION Physician-reported 1ry nonresponse was more correlated with non-achievement of DAS28-ESR LDA or CDAI LDA, whereas 2ry nonresponse with actual time of discontinuation. Further work is needed to confirm the importance of response and type of response to the initial anti-TNF in identifying patients most likely to benefit from a second biologic agent treatment.
Collapse
Affiliation(s)
- Edward C Keystone
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada. .,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology.
| | - Emmanouil Rampakakis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Mohammad Movahedi
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Angela Cesta
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Melissa Stutz
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - John S Sampalis
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Francois Nantel
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Karina Maslova
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| | - Claire Bombardier
- From The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; Toronto General Hospital Research Institute, University Health Network; Janssen Inc.; University of Toronto, Department of Medicine (DMO) and Institute of Health Policy, Management, and Evaluation (IHPME); Mount Sinai Hospital, Division of Rheumatology, Toronto, Ontario; JSS Medical Research Inc., Montreal, Quebec, Canada.,E.C. Keystone, MD, The Rebecca MacDonald Centre for Arthritis, Mount Sinai Hospital; E. Rampakakis, PhD, JSS Medical Research Inc.; M. Movahedi, MD, PhD, Toronto General Hospital Research Institute, University Health Network; A. Cesta, MSc, Toronto General Hospital Research Institute, University Health Network; M. Stutz, MSc, JSS Medical Research Inc.; J.S. Sampalis, PhD, JSS Medical Research Inc.; F. Nantel, PhD, Janssen Inc.; K. Maslova, PhD, Janssen Inc.; C. Bombardier, MD, Toronto General Hospital Research Institute, University Health Network, and University of Toronto, DMO and IHPME, and Mount Sinai Hospital, Division of Rheumatology
| |
Collapse
|
39
|
Ammendolia C, Côté P, Rampersaud YR, Southerst D, Schneider M, Ahmed A, Bombardier C, Hawker G, Budgell B. Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial. Chiropr Man Therap 2019; 27:24. [PMID: 31244992 PMCID: PMC6582553 DOI: 10.1186/s12998-019-0245-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background context Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrical stimulation of the skin. Purpose The aim of this study was to assess the effectiveness of active para-spinal transcutaneous electrical nerve stimulation (TENS) compared to de-tuned TENS applied while walking, on improving walking ability in LSS. Study design This was a two-arm double-blinded (participant and assessor) randomized controlled trial. Patient sample We recruited 104 participants 50 years of age or older with neurogenic claudication, imaging confirmed LSS and limited walking ability. Outcome measures The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. Methods The active TENS group (n = 49) received para-spinal TENS from L3-S1 at a frequency of 65-100 Hz modulated over 3-s intervals with a pulse width of 100-200 usec, and turned on 2 min before the start and maintained during the SPWT. The de-tuned TENS group (n = 51) received similarly applied TENS for 30 s followed by ramping down to zero stimulus and turned off before the start and during the SPWT.Study funded by The Arthritis Society ($365,000 CAN) and salary support for Carlo Ammendolia funded by the Canadian Chiropractic Research Foundation ($500,000 CAN over 5 years). Results From August 2014 to January 2016 a total of 640 potential participants were screened for eligibility; 106 were eligible and 104 were randomly allocated to active TENS or de-tuned TENS. Both groups showed significant improvement in walking distance but there was no significant difference between groups. The mean difference between active and de-tuned TENS groups was 46.9 m; 95% CI (- 118.4 to 212.1); P = 0.57. A total of 71% (35/49) of active TENS and 74% (38/51) of de-tuned TENS participants achieved at least 30% improvement in walking distance; relative risk (RR), 0.96; 95% CI, (0.7 to 1.2) P = 0.77. Conclusions Active TENS applied while walking is no better than de-tuned TENS for improving walking ability in patients with degenerative LSS and therefore should not be a recommended treatment in clinical practice. Registration ClinicalTrials.gov ID: NCT02592642. Registration October 30, 2015.
Collapse
Affiliation(s)
- Carlo Ammendolia
- 1Institute of Health Policy, Management and Evaluation, University of Toronto, 60 Murray Street, Rm L2-225, Toronto, Ontario M5T 3L9 Canada.,2Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, 60 Murray Street, Rm L2-225, Toronto, Ontario M5T 3L9 Canada
| | - Pierre Côté
- 1Institute of Health Policy, Management and Evaluation, University of Toronto, 60 Murray Street, Rm L2-225, Toronto, Ontario M5T 3L9 Canada.,3Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,4UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario Canada
| | - Y Raja Rampersaud
- Department of Orthopedics, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 441, 1 East Wing, Toronto, Ontario M5T 2S8 Canada
| | - Danielle Southerst
- 6Occupational and Industrial Orthopaedic Centre, Department of Orthopaedic Surgery, NYU Langone Health, 63 Downing Street, New York, NY 10014 USA
| | - Michael Schneider
- 7Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219 USA
| | - Aksa Ahmed
- 2Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, 60 Murray Street, Rm L2-225, Toronto, Ontario M5T 3L9 Canada
| | - Claire Bombardier
- 8Department of Medicine, Division of Rheumatology, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario M5G 2C4 Canada.,9Department of Medicine, Faculty of Medicine, University of Toronto, P.O. Box 7, 60 Murray Street, Rm L2-008, Toronto, Ontario M5T 3L9 Canada
| | - Gillian Hawker
- 8Department of Medicine, Division of Rheumatology, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, Ontario M5G 2C4 Canada.,9Department of Medicine, Faculty of Medicine, University of Toronto, P.O. Box 7, 60 Murray Street, Rm L2-008, Toronto, Ontario M5T 3L9 Canada
| | - Brian Budgell
- 10Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, Ontario M2H 3J1 Canada
| |
Collapse
|
40
|
Ahluwalia V, Lineker S, Sweezie R, Bell MJ, Kendzerska T, Widdifield J, Bombardier C. The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario. J Rheumatol 2019; 47:461-467. [PMID: 31154411 DOI: 10.3899/jrheum.180734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We evaluated the influence of triage assessments by extended role practitioners (ERP) on improving timeliness of rheumatology consultations for patients with suspected inflammatory arthritis (IA) or systemic autoimmune rheumatic diseases (SARD). METHODS Rheumatologists reviewed primary care providers' referrals and identified patients with inadequate referral information, so that a decision about priority could not be made. Patients were assessed by an ERP to identify those with IA/SARD requiring an expedited rheumatologist consult. The time from referral to the first consultation was determined comparing patients who were expedited to those who were not, and to similar patients in a usual care control group identified through retrospective chart review. RESULTS Seven rheumatologists from 5 communities participated in the study. Among 177 patients who received an ERP triage assessment, 75 patients were expedited and 102 were not. Expedited patients had a significantly shorter median (interquartile range) wait time to rheumatologist consult: 37.0 (24.5-55.5) days compared to non-expedited patients [105 (71.0-135.0) days] and controls [58.0 (24.0-104.0) days]. Accuracy comparing the ERP identification of IA/SARD to that of the rheumatologists was fair (κ 0.39, 95% CI 0.25-0.53). CONCLUSION Patients triaged and expedited by ERP experienced shorter wait times compared to usual care; however, some patients with IA/SARD were missed and waited longer. Our findings suggest that ERP working in a triage role can improve access to care for those patients correctly identified with IA/SARD. Further research needs to identify an ongoing ERP educational process to ensure the success of the model.
Collapse
Affiliation(s)
- Vandana Ahluwalia
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society. .,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto.
| | - Sydney Lineker
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Raquel Sweezie
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Mary J Bell
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Tetyana Kendzerska
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Jessica Widdifield
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | - Claire Bombardier
- From the Ontario (Canada) Rheumatology Association, Ontario Best Practices Research Initiative, and the Arthritis Society.,V. Ahluwalia, MD, FRCPC, William Osler Health System; S. Lineker, PhD, Arthritis Society; R. Sweezie, PhD, Arthritis Society; M.J. Bell, MD, FRCPC, Sunnybrook Health Sciences Centre; T. Kendzerska, MD, PhD, The Ottawa Hospital Research Institute, University of Ottawa; J. Widdifield, PhD, Sunnybrook Research Institute, Institute for Clinical Evaluative Sciences, Institute of Health Policy, Management and Evaluation, University of Toronto; C. Bombardier, MD, FRCPC, University of Toronto
| | | |
Collapse
|
41
|
Movahedi M, Joshi R, Rampakakis E, Thorne C, Cesta A, Sampalis JS, Bombardier C. Impact of residential area on the management of rheumatoid arthritis patients initiating their first biologic DMARD: Results from the Ontario Best Practices Research Initiative (OBRI). Medicine (Baltimore) 2019; 98:e15517. [PMID: 31096451 PMCID: PMC6531262 DOI: 10.1097/md.0000000000015517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Access to care and management of Rheumatoid Arthritis (RA) patients may differ based on residential area. We described differences in the profile of patients initiating their first biologic disease modifying antirheumatic drug (bDMARD) based on their residential area type.Cross-sectional analysis of 793 adult RA patients in the longitudinal Ontario Best Practices Research Initiative (OBRI) registry initiating their first bDMARD <30 days prior to or anytime post-enrolment. Patient residential and clinic areas (rural vs. urban) were classified using 2 methods: postal codes and Statistics Canada population centres. Sociodemographics, disease characteristics, and RA medications (tumor necrosis factor inhibitor [TNFi] vs. non-TNFi, concurrent use of conventional synthetic DMARDs [csDMARDs], and intravenous [IV] vs. subcutaneous [SC] bDMARD) at initiation of first bDMARD were contrasted between residential area types.Other than marital status, first language, and race (higher proportion of married, English speaking, Caucasian patients in rural areas), no significant differences were observed in the demographic and disease characteristics of patients living in rural and urban areas. In multivariate analysis, there was no association between residential area type and type of bDMARD use, concurrent csDMARD(s) use or route of bDMARD. However, patients living farther from their treating clinic were significantly less likely to initiate IV bDMARD. Female rheumatologist and rural clinic location were independently associated with lower odds of IV bDMARD use.The use of SC vs. IV bDMARD was associated with being seen in a clinic located in a rural area, being treated by a female rheumatologist, and living farther from treating clinic. These results suggest possible prescription bias in bDMARD selection and/or patient preferences due to convenience.
Collapse
Affiliation(s)
- Mohammad Movahedi
- Ontario Best Practices Research Initiative, Toronto General Research Institute University Health Network, Toronto
- JSS Medical Research, St-Laurent, QC
| | - Raman Joshi
- William Osler Health System, Brampton Civic Hospital, Brampton
| | | | | | - Angela Cesta
- Ontario Best Practices Research Initiative, Toronto General Research Institute University Health Network, Toronto
| | | | - Claire Bombardier
- Ontario Best Practices Research Initiative, Toronto General Research Institute University Health Network, Toronto
- Department of Medicine (DOM) and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto
- Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
42
|
Lau AN, Thorne JC, Movahedi M, Rampakakis E, Cesta A, Li X, Couto S, Sampalis J, Bombardier C. Effect of Concomitant Disease-modifying Antirheumatic Drugs and Methotrexate Administration Route on Biologic Treatment Durability in Rheumatoid Arthritis: OBRI Cohort Results. J Rheumatol 2019; 46:874-886. [DOI: 10.3899/jrheum.180486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
Objective.Prior studies have suggested that concurrent conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy enhances the efficacy of biologic DMARD (bDMARD). Here, we assessed the effect of concomitant csDMARD use and methotrexate (MTX) route of administration on time to bDMARD discontinuation in a large Canadian (Ontario), observational, rheumatoid arthritis (RA) cohort.Methods.Patients from the Ontario Best Practices Research Initiative (OBRI) who initiated bDMARD therapy and had ≥ 1 followup assessment were included. The effect of concomitant csDMARD use (primary analysis) and MTX route of administration (secondary analysis) on bDMARD discontinuation owing to (1) any reason, (2) ineffectiveness, (3) adverse events (AE), and (4) both (2) and (3), were assessed with multivariate Cox regression.Results.Among the 814 patients included, 153 (18.8%) received bDMARD monotherapy and 661 (81.2%) combination csDMARD/bDMARD therapy. Over a mean followup of 1.9 years, bDMARD were discontinued in 38.7% of patients. In multivariate analysis, there was a nonsignificant trend toward lower discontinuation for the csDMARD/bDMARD group compared to bDMARD monotherapy for any reason (HR 0.76, 95% CI 0.55–1.05) and owing to ineffectiveness/AE (HR 0.73, 95% CI 0.50–1.06). Further, patients taking combination therapy had significantly lower risk of bDMARD discontinuation due to AE (HR 0.43, 95% CI 0.24–0.76). In the secondary analysis, no statistical association between MTX dose or route of administration and bDMARD durability was observed.Conclusion.Concomitant csDMARD use was associated with a significantly lower hazard for bDMARD discontinuation due to AE among patients with RA followed in routine clinical practice in Ontario, Canada. Neither MTX route of administration nor dose were significant predictors of bDMARD durability.
Collapse
|
43
|
Ammendolia C, Rampersaud YR, Southerst D, Ahmed A, Schneider M, Hawker G, Bombardier C, Côté P. Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial. Spine J 2019; 19:386-394. [PMID: 30053521 DOI: 10.1016/j.spinee.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuroischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking. PURPOSE The aim of this study was to assess the short-term effectiveness of a prototype LSS belt compared to a lumbar support in improving walking ability in patients with degenerative LSS. STUDY DESIGN This was a two-arm, double-blinded (participant and assessor) randomized controlled trial. PATIENT SAMPLE We recruited 104 participants aged 50 years or older with neurogenic claudication, imaging confirmed degenerative LSS, and limited walking ability. OUTCOME MEASURES The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. METHODS Within 1 week of a baseline SPWT, participants randomized to the prototype LSS belt group (n=52) and those randomized to the lumbar support group (n=52) performed a SPWT that was conducted by a blinded assessor. The Arthritis Society funded this study ($365,000 CAN) with salary support for principal investigator funded by the Canadian Chiropractic Research Foundation ($500,000 CAN for 5 years). RESULTS Both groups showed significant improvement in walking distance, but there was no significant difference between groups. The mean group difference in walking distance was -74 m (95% CI: -282.8 to 134.8, p=.49). In total, 62% of participants wearing the prototype LSS belt and 82% of participants wearing the lumbar support achieved at least 30% improvement in walking distance (relative risk, 0.7; 95% CI: 0.5-1.3, p=.43). CONCLUSIONS A prototype LSS belt demonstrated significant improvement in walking ability in degenerative LSS but was no better than a lumbar support.
Collapse
Affiliation(s)
- Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON Canada M5T 3M6; Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, 60 Murray Street, Room L2-225, Toronto, Ontario M5T 3L9, Canada.
| | - Y Raja Rampersaud
- Department of Orthopedics, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON Canada M5T 2S8
| | - Danielle Southerst
- Occupational and Industrial Center, Department of Orthopaedic Surgery, NYU Langone Health, 63 Downing St. New York, NY 10014, USA
| | - Aksa Ahmed
- Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, 60 Murray Street, Room L2-225, Toronto, Ontario M5T 3L9, Canada
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, 4028 Forbes Tower Pittsburgh, PA 15260, USA
| | - Gillian Hawker
- Department of Medicine, Division of Rheumatology, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, Canada, M5S 1A8; Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, Canada M5S 1A8
| | - Claire Bombardier
- Department of Medicine, Division of Rheumatology, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, Canada, M5S 1A8; Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, Ontario, Canada M5S 1A8
| | - Pierre Côté
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON Canada M5T 3M6; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, Canada, M5T 3M7; UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North Oshawa, Ontario, Canada L1H 7K4
| |
Collapse
|
44
|
Pope JE, Movahedi M, Rampakakis E, Cesta A, Sampalis JS, Keystone E, Thorne C, Bombardier C. ACPA and RF as predictors of sustained clinical remission in patients with rheumatoid arthritis: data from the Ontario Best practices Research Initiative (OBRI). RMD Open 2018; 4:e000738. [PMID: 30487995 PMCID: PMC6241994 DOI: 10.1136/rmdopen-2018-000738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 12/29/2022] Open
Abstract
Objective(s) This study evaluated the interaction of anticitrullinated protein antibody (ACPA) and rheumatoid factor (RF) in predicting sustained clinical response in an observational registry of patients with rheumatoid arthritis (RA) followed in routine practice. Methods Patients with RA enrolled in the Ontario Best Practices Research Initiative registry, with ≥1 swollen joint, autoantibody information and ≥1 follow-up assessment were included. Sustained clinical remission was defined as Clinical Disease Activity Index (CDAI) ≤2.8 in at least two sequential visits separated by 3–12 months. Time to sustained remission was assessed using cumulative incidence curves and multivariate cox regression. Results Among 3251 patients in the registry, 970 were included, of whom 262 (27%) were ACPAneg/RFneg, 60 (6.2%) ACPApos /RFneg, 117 (12.1%) ACPAneg/RFpos and 531 (54.7%) ACPApos /RFpos at baseline. Significant between group differences were observed in age (p=0.02), CDAI (p=0.03), tender joint count (p=0.02) and Health Assessment Questionnaire (p=0.002), with ACPApos patients being youngest with lowest disease activity and disability. No difference in biologic use was found between groups (20.2% of patients). Over a mean follow-up of 3 years, sustained remission was achieved by 43.5% of ACPApos/RFpos patients, 43.3% of ACPApos /RFneg patients, 31.6 % of ACPAneg/RFpos patients and 32.4% of ACPAneg/RFneg patients (p=0.01). Significant differences were observed in CDAI improvement based on ACPA and RF status where ACPApos/RFpos had a shorter time to achieving sustained remission (HR 1.30; 95% CI 1.01 to 1.67) and experienced significantly higher improvements compared with ACPAneg/RFneg patients. Conclusion(s) Combined ACPA and RF positivity were associated with improved and faster response to antirheumatic medications in patients with RA.
Collapse
Affiliation(s)
- Janet E Pope
- Department of Medicine, Division of Rheumatology, University of Western Ontario, Saint Joseph's Health Care, Ontario, London, Canada
| | - Mohammad Movahedi
- JSS Medical Research, St-Laurent, Quebec, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, London, Canada
| | | | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, London, Canada
| | - John S Sampalis
- JSS Medical Research, St-Laurent, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Edward Keystone
- Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Quebec, Canada
| | - Carter Thorne
- Southlake Regional Health Centre, Newmarket, Quebec, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, London, Canada.,Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Quebec, Canada.,Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Quebec, Canada
| |
Collapse
|
45
|
Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, Hawker G, Rampersaud YR. Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial. Arch Phys Med Rehabil 2018; 99:2408-2419.e2. [PMID: 29935152 DOI: 10.1016/j.apmr.2018.05.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis (LSS). DESIGN Randomized controlled trial. SETTING Academic hospital outpatient clinic. PARTICIPANTS Participants (N=104) with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were women, 84% had leg symptoms for >12 months, and the mean maximum walking capacity was 328.7 m. INTERVENTIONS A 6-week structured comprehensive training program or a 6-week self-directed program. MAIN OUTCOME MEASURES Continuous walking distance in meters measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (minimally clinically important difference [MCID]) in the SPWT at 6 months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score, and the Short-Form General Health Survey subscales. RESULTS A total of 48 versus 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment, respectively, received the intervention and 89% of the total study sample completed the study. At 6 months, the adjusted mean difference in walking distance from baseline was 421.0 m (95% confidence interval [95% CI], 181.4-660.6), favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID (adjusted relative risk, 1.3; 95% CI, 1.0-1.7; P=.03). Both primary treatment effects persisted at 12 months favoring the comprehensive program. At 6 months, the ODI walk score and at 12 months the ZCQ, Medical Outcomes Study 36-Item Short-Form Health Survey-physical function and -bodily pain scores showed greater improvements favoring the comprehensive program. CONCLUSIONS A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS.
Collapse
Affiliation(s)
- Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Rebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Pierre Côté
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology and UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
| | - Danielle Southerst
- Occupational and Industrial Orthopaedic Centre, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Brian Budgell
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Claire Bombardier
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Hawker
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Department of Orthopedics, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
46
|
Kuriya B, Joshi R, Movahedi M, Rampakakis E, Sampalis JS, Bombardier C. High Disease Activity Is Associated with Self-reported Depression and Predicts Persistent Depression in Early Rheumatoid Arthritis: Results from the Ontario Best Practices Research Initiative. J Rheumatol 2018; 45:1101-1108. [DOI: 10.3899/jrheum.171195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
Objective.We sought to determine if initial high disease activity or changes in disease activity contribute to persistent depression in early rheumatoid arthritis (ERA). We also determined if disease activity and depression is modified by sex.Methods.Depression was ascertained by self-report among patients enrolled in the Ontario Best Practices Research Initiative. The association between baseline disease activity, measured by the Clinical Disease Activity Index (CDAI), and persistent depression was evaluated with multivariate regression models, and effect modification by sex was tested. A general estimating equation assessed the association between change in CDAI over time and risk of depression.Results.The sample of 469 ERA subjects was predominantly female (73%). At baseline, the prevalence of depression was 26%, and 23% reported persistent depression. After adjusting for potential confounders, higher baseline CDAI was associated with both baseline and persistent depression (OR 1.03, 95% CI 1.01–1.05). Female sex was an effect modifier of this relationship (OR 1.04, 95% CI 1.01–1.06). Maintaining a moderate or high CDAI score over 2 years also increased the risk of future depression.Conclusion.Depression in ERA is common and initial high disease activity is associated with the probability of depression and its persistence. This risk seems particularly modified in women with active disease and represents an area for targeted focus and screening. Future studies in ERA are needed to determine if intervening during the “window of opportunity” to control disease activity has the potential to mitigate the development and maintenance of adverse mental health outcomes, including depression.
Collapse
|
47
|
Pope JE, Rampakakis E, Movahedi M, Cesta A, Li X, Couto S, Sampalis JS, Bombardier C. Treatment patterns in rheumatoid arthritis after discontinuation of methotrexate: data from the Ontario Best Practices Research Initiative (OBRI). Clin Exp Rheumatol 2018; 36:215-222. [PMID: 29148403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/23/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES In active rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX), guidelines support adding or switching to another conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) and/or a biologic DMARD (bDMARD). The purpose of this analysis was to describe treatment practices in routine care and to evaluate determinants of regimen selection after MTX discontinuation. METHODS Biologic-naïve patients in the Ontario Best Practice Research Initiatives registry discontinuing MTX due to primary/secondary failure, adverse events, or patient/physician decision were included. RESULTS Of 313 patients discontinuing MTX, 102 (32.6%) were on MTX monotherapy, 156 (49.8%) on double, and 55 (17.6%) on multiple csDMARDs. Patients on MTX monotherapy were older than patients on double or multiple csDMARDs (p=0.013), less likely to have joint erosions (p=0.009) and had lower patient global assessment (p=0.046) at MTX discontinuation. Post-MTX discontinuation, 169 (54.0%) transitioned to, or added new DMARD(s) (new csDMARD(s): 139 [44.4%]; bDMARD: 30 [9.6%]), and 144 (46.0%) opted for no new DMARD treatment. Patients on MTX monotherapy transitioning monotherapy, whereas patients on combination csDMARDs switched more to new csDMARDs and bDMARD combination therapy. Early RA (adjOR [95%CI]: 3.07 [1.40-6.72]) and treatment with multiple csDMARDs vs. MTX monotherapy (4.15 [1.35-12.8]) at MTX discontinuation were significant predictors of transitioning to or adding new csDMARD(s)/bDMARD treatment versus opting for no new DMARD treatment. CONCLUSIONS Differences in subsequent treatment patterns exist between patients discontinuing MTX when used as monotherapy versus in combination with other csDMARDs where the former are more likely to use a subsequent monotherapy treatment.
Collapse
Affiliation(s)
- Janet E Pope
- University of Western Ontario, London; Saint Joseph's Health Care, London, ON, Canada.
| | | | - Mohammad Movahedi
- JSS Medical Research, St-Laurent, QC; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sandra Couto
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - John S Sampalis
- JSS Medical Research, St-Laurent, QC; McGill University, Montreal, QC, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto; Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
48
|
Hazlewood GS, Bombardier C, Tomlinson G, Marshall D. A Bayesian model that jointly considers comparative effectiveness research and patients’ preferences may help inform GRADE recommendations: an application to rheumatoid arthritis treatment recommendations. J Clin Epidemiol 2018; 93:56-65. [DOI: 10.1016/j.jclinepi.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/05/2017] [Accepted: 10/08/2017] [Indexed: 12/21/2022]
|
49
|
Kongsted A, Hestbaek L, Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, Hawker G, Raja Rampersaud Y, Minder C, Peterson C, Kim Humphreys B, Gíslason HF, Salminen JK, Sandhaugen L, Storbråten AS, Versloot R, Rouge I, Newell D, Aartun E, Yu H, Côté P, Poulsen E, Goncalves GH, Roos EM, Thorlund JB, Juhl C, Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Bodin L, Lebouf-Yde C, Kongsted A, Axén I, Dissing KB, Hartvigsen J, Williams C, Kamper S, Boyle E, Wedderkopp N, Hestbæk L, Meier ML, Schweinhardt P, Humphreys K, Miller A, Miller J, Miller A, Miller J, Miller A, Miller J, Taylor A, Way S, Wirth B, Schweinhardt P, Humphreys K, Alvarenga BAP, Botelho MB, Lara JPR, Veloso AP, Bergström C, Persson M, Mogren I, Janine Thöni B, Peterson C, Kim Humphreys B, Guillén D, Peterson C, Kim Humphreys B, Heritage D, Miller J, Byfield D, Newsam A, Byfield D, Toprak M, Alptekim HK, Turhan D, Mellars H, Miller J, Rix J, Dewhurst P, Rix J, Cooke C, Newell D, Alcantara J, Ohm J, Alcantara J, Alcantara J, Ohm J, Alcantara J, Field J, Newell D, Hanson H, Miller J, Mandy H, Derek L, Zicheng M, Han TY, Joyce M, Fuglkjær S, Dissing KB, Hestbæk L, Schweinhardt P, Wirth B, Peterson G, Humphreys BK, Raven TL, Lothe LR, Eken T, Serola R. ECU convention 2017 research presentations. Chiropr Man Therap 2017. [PMCID: PMC5773907 DOI: 10.1186/s12998-017-0166-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
50
|
Barber CEH, Mosher DP, Ahluwalia V, Zummer M, Marshall DA, Choquette D, Lacaille D, Bombardier C, Lyddiatt A, Chandran V, Khodyakov D, Dao E, Barnabe C. Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis. J Rheumatol 2017; 44:1813-1822. [PMID: 28966205 DOI: 10.3899/jrheum.170421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Canadian Rheumatoid Arthritis Core Clinical Dataset (CAN-RACCD) to standardize documentation encouraging high-quality care. METHODS A set of candidate elements was drafted through meetings with 27 rheumatologists, researchers, and patients, and supplemented with focused literature reviews. A 3-round online-modified Delphi consensus process was held with rheumatologists (n = 26), allied health professionals (n = 7), and patients (n = 4); for the remainder there was no demographic information. Participants rated both the importance and feasibility of documenting candidate elements on a Likert scale of 1-9, contributed to an online moderated discussion, and re-rated the elements for inclusion in the CAN-RACCD. Elements were included in the final set if importance and feasibility ratings had a median score of ≥ 6.5 and there was no disagreement among participants. RESULTS Fifty-five individual elements in 10 subgroups were proposed to the Delphi participants: measures of RA disease activity; dates to calculate waiting times, disease duration, and disease-modifying antirheumatic drug start; comorbidities; smoking status; patient-reported pain and fatigue; physical function; laboratory and radiographic investigations; medications; clinical characteristics; and vaccines. All groups were included in the final set, with the exception of vaccination status. Additionally, 3 individual elements from the smoking subgroup were eliminated with a recommendation to record smoking status as never/ever/current, and 2 elements relating to coping and effect of fatigue were eliminated due to low feasibility and importance ratings. CONCLUSION The CAN-RACCD stands as a national recommendation on which data elements should be routinely collected in clinical practice to monitor and support high-quality RA care.
Collapse
Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA. .,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary.
| | - Dianne P Mosher
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Vandana Ahluwalia
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Michel Zummer
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Denis Choquette
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Claire Bombardier
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Anne Lyddiatt
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Vinod Chandran
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Dmitry Khodyakov
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Emily Dao
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | | | | |
Collapse
|