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O'Brien J, Park SH, Blachley T, Marchese M, Middaugh N, Wittstock K, Harrold LR. Disparities in burden of disease in patients with rheumatoid arthritis across racial and ethnic groups. Clin Rheumatol 2024; 43:921-927. [PMID: 38267768 PMCID: PMC10876763 DOI: 10.1007/s10067-024-06869-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
To examine racial/ethnic differences in rheumatoid arthritis (RA) disease burden and change in clinical outcomes over time. We included CorEvitas Rheumatoid Arthritis Registry patients from two time periods (2013-2015 and 2018-2020). Clinical Disease Activity Index (CDAI) (as a continuous measure and as a dichotomous measure) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) were assessed at each visit. Marginal means and their corresponding 95% confidence interval (CI) by race/ethnicity were estimated for each outcome using adjusted mixed effects linear and logistic regression models. Overall and pairwise tests were conducted to detect differences between race/ethnicity groups. Of 9,363 eligible patients (8,142 White, 527 Black, 545 Hispanic, 149 Asian), most (76%-85%) were female. At Visit 1, the mean disease duration ranged from 9.8-11.8 years. Estimated CDAI was significantly higher for Hispanics compared to Whites at Visit 1 (11.1 vs. 9.9; pairwise P = 0.033) and Visit 2 (9.2 vs. 8.0, pairwise P = 0.005). Disease activity improved over the 5-year study period among all race/ethnicity groups, though Hispanics improved less than Whites. Disease activity improved over the 5-year period across all racial/ethnicity groups, and disparities between racial/ethnicity groups in disease activity and functional status did persist over time, suggesting that further effort is needed to understand the drivers of these discrepancies to close this race/ethnicity gap. Key Points • Disease activity improved over the 5-year period across all racial and ethnic groups. • Disparities between racial and ethnic groups in disease activity and functional status did persist over time, suggesting that further effort is needed to understand the drivers of these discrepancies and close this racial gap.
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Affiliation(s)
| | | | | | | | | | | | - Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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Mease PJ, Blachley T, Malatestinic WN, Harrold LR, Dube B, Lisse JR, Bolce RJ, Hunter TM. Effectiveness of bDMARDs in ankylosing spondylitis patients by biologic use: experience from the CorEvitas PsA/SpA Registry. Curr Med Res Opin 2024; 40:315-323. [PMID: 38050693 DOI: 10.1080/03007995.2023.2291160] [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] [Received: 06/05/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe bDMARD initiators by biologic experience among ankylosing spondylitis (AS) patients and change in disease activity and patient-reported outcomes (PROs) in real-world US patients. METHODS We included patients ≥18 years with AS based on physician diagnosis enrolled between 3/2013 and 11/2019 in the CorEvitas Psoriatic Arthritis (PSA)/Spondyloarthritis Registry (NCT02530268). Patients concurrently diagnosed with PSA were excluded. Baseline (bDMARD initiation) demographics, comorbidities, disease characteristics, treatment, and PROs were collected. Response rates and changes in disease activity and PROs between baseline and 6- and 12- month follow-up visits were calculated. RESULTS Of the 489 AS patients in the PsA/SpA Registry, 254 AS (52.0%) patients initiated a bDMARD at enrollment or during follow-up (total initiations: AS = 313). Of the 313 AS initiations, 179 (57.2%) had a 6-month follow-up, 122 (39.0%) had a 12-month follow-up, and 94 (30.0%) had a 6- and 12-month follow-up visit. For those AS initiators with a 6-month follow-up, the mean age was 49.1 years, 44.4% were female, and 70.4%, 47.5%, 96.1%, and 46.9% had never used cDMARDs, TNFis, non-TNFis, and bDMARDs, respectively. Of these 179 AS initiators, 20.1% and 14.0% achieved ASAS20/40, respectively. Further, only 34% achieved low disease activity (ASDAS <2.1). When stratified by biologic-naivete and biologic-experience, the ASAS 20/40 achievement rates were 26.2% and 14.7%, and 21.4% and 7.4%, respectively, for this cohort. CONCLUSION Although AS patients initiate bDMARDs, many do not achieve optimal treatment responses. Future research is needed to investigate the aspects associated with inadequate improvement and treatment response to bDMARDs.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | | | | | - Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
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Harrold LR, Wittstock K, Kelly S, Han X, Zhuo J, Schrader A, Middaugh N, Moore PC, Khaychuk V. Comparative effectiveness of abatacept versus TNF inhibitors in rheumatoid arthritis patients who are ACPA and shared epitope positive. Adv Rheumatol 2024; 64:10. [PMID: 38243281 DOI: 10.1186/s42358-024-00352-4] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The HLA-DRB1 shared epitope (SE) is a risk factor for the development of rheumatoid arthritis (RA) and the production of anti-citrullinated protein antibodies (ACPAs) in RA patients. Our objective was to examine the real-world effectiveness of abatacept versus tumor necrosis factor inhibitors (TNFi) in patients with RA who were SE and anti-cyclic citrullinated peptide antibody (anti-CCP3) positive. METHODS Abatacept or TNFi initiators who were SE + and anti-CCP3+ (> 20 U/mL) at or prior to treatment and had moderate or high CDAI score (> 10) at initiation were identified. The primary outcome was mean change in CDAI score over six months. Analyses were conducted in propensity score (PS)-trimmed and -matched populations overall and a biologic-experienced subgroup. Mixed-effects models were used. RESULTS In the overall PS-trimmed (abatacept, n = 170; TNFi, n = 157) and PS-matched cohorts (abatacept, n = 111; TNFi, n = 111), there were numerically greater improvements in mean change in CDAI between abatacept and TNFi but were not statistically significant. Similar trends were seen for biologic-experienced patients, except that statistical significance was reached for mean change in CDAI in the PS-trimmed cohort (abatacept, 12.22 [95% confidence interval (95%CI) 10.13 to 14.31]; TNFi, 9.28 [95%CI 7.08 to 11.48]; p = 0.045). CONCLUSION In this real world cohort, there were numerical improvements in efficacy outcomes with abatacept over TNFi in patients with RA who were SE + and ACPA+, similar to results from a clinical trial population The only statistically significant finding after adjusting for covariates was greater improvement in CDAI with abatacept versus TNFi in the bio-experienced PS-trimmed cohort..
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Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, 350 5th Avenue, Waltham, MA, 02451, USA.
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | - Xue Han
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Joe Zhuo
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Amy Schrader
- CorEvitas, LLC, 350 5th Avenue, Waltham, MA, 02451, USA
| | | | - Page C Moore
- CorEvitas, LLC, 350 5th Avenue, Waltham, MA, 02451, USA
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Harrold LR, Zueger P, Nowell WB, Blachley T, Schrader A, Lakin PR, Curtis D, Stradford L, Venkatachalam S, Tundia N, Patel PA. A Real-World Effectiveness Study Using a Mobile Application to Evaluate Early Outcomes with Upadacitinib in Rheumatoid Arthritis. Rheumatol Ther 2023; 10:1519-1533. [PMID: 37728861 PMCID: PMC10654297 DOI: 10.1007/s40744-023-00594-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION The impact of upadacitinib on rheumatoid arthritis (RA) symptoms was evaluated during the first 12 weeks of treatment via patient-reported outcomes (PROs) using a mobile health application (app). METHODS Participating rheumatologists from the CorEvitas RA Registry (prospective, observational cohort) recruited patients with RA initiating upadacitinib treatment. A modified version of the ArthritisPower® app was used to collect PROs, including the Routine Assessment of Patient Index Data 3 (RAPID3), duration of morning joint stiffness, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue 7a Short Form at baseline and weeks 1-4, 8, and 12. RAPID3 responses over time were assessed using Kaplan-Meier estimation to determine the proportion of patients achieving disease activity improvement and minimal clinically important difference (MCID). Results were analyzed for all patients initiating upadacitinib and a subsample of TNF inhibitor (TNFi)-experienced patients with moderate to severe disease at baseline. RESULTS A total of 103 patients with RA initiating upadacitinib (62.1% TNFi-experienced) were included. At week 12, 53 patients (51.4%) completed the study and provided PRO data via the app. Among all patients, improvements in RAPID3, pain, morning stiffness, and fatigue were observed at week 1 and were maintained or further improved through week 12. At week 12, 37.5% of patients achieved RAPID3 low disease activity. Starting at week 1, improvements in RAPID3 disease activity category (19.4% of patients) and achievement of MCID (16.3%) were reported, with nearly 50% of patients achieving these outcomes by week 4 (RAPID3 category: 48.8%; MCID: 49.2%) and 60% by week 12 (RAPID3 category: 59.6%; MCID: 59.8%). TNFi-experienced patients generally reported similar outcomes. Patient-reported medication convenience and compliance were generally high. CONCLUSIONS In this real-world cohort of patients with RA, treatment with upadacitinib was associated with early and significant improvement in RAPID3, pain, morning stiffness, and fatigue regardless of prior TNFi experience. Clinically meaningful improvement in RAPID3 patient-reported disease activity was observed as early as week 1, with continued improvement reported through week 12.
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Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA.
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | | | - Amy Schrader
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA
| | - Paul R Lakin
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA
| | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, NY, USA
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Galvao RW, Curtis JR, Harrold LR, Wu Q, Xie F, George MD. Accuracy of administrative claims prescription fill data to estimate glucocorticoid use and dose in patients with rheumatoid arthritis. Pharmacoepidemiol Drug Saf 2023; 32:1271-1279. [PMID: 37345649 PMCID: PMC10543479 DOI: 10.1002/pds.5660] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To assess accuracy of administrative claims prescription fill-based estimates of glucocorticoid use and dose, and approximate bias from glucocorticoid exposure misclassification. METHODS We identified adults with rheumatoid arthritis with linked Medicare and CorEvitas registry data. An algorithm identifying glucocorticoid use and average dose over 90 days from Medicare prescription fills was compared to physician-reported measures from a CorEvitas visit during the same period, using weighted kappa to compare doses (none, ≤5 mg, 5-10 mg, >10 mg/day). A deterministic sensitivity analysis examined the effect of exposure misclassification on estimated glucocorticoid-associated infection risk from a prior study. RESULTS We identified 621 observations among 494 patients. Prescription fills identified glucocorticoid use in 41.9% of observations versus 31.1% identified by CorEvitas physician-report. For glucocorticoid use (yes/no), prescription fills had sensitivity 88.1% (95% CI 82.7-92.3), specificity 79.0% (74.8-82.7), PPV 65.4% (59.3-71.2), NPV 93.6% (90.6-95.9), and 81.8% agreement with CorEvitas, with kappa 0.61 (moderate to substantial agreement). There was 89.5% agreement between prescription fills and physician-reported doses, with weighted kappa 0.56 (moderate agreement). Applying these results to a prior Medicare study evaluating glucocorticoid-associated infection risk [risk ratio 1.44 (95% CI 1.41-1.48)] led to an externally adjusted risk ratio of 1.74 when accounting for exposure misclassification, representing -17% bias in infection risk estimate. CONCLUSIONS This study supports the use of claims data to estimate glucocorticoid use and dose, but investigators should account for exposure misclassification, which may lead to underestimates of glucocorticoid risks. Our results could be applied to adjust risk estimates in other studies that use prescription fills to estimate glucocorticoid use.
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Affiliation(s)
- Rachel W. Galvao
- Yale University, New Haven, CT
- University of Pennsylvania, Philadelphia, PA
| | | | - Leslie R. Harrold
- CorEvitas, Waltham, MA
- University of Massachusetts Medical School, Worcester, MA
| | - Qufei Wu
- University of Pennsylvania, Philadelphia, PA
| | - Fenglong Xie
- University of Alabama at Birmingham, Birmingham, AL
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Yun H, George MD, Greenberg J, Harrold LR, Curtis JR. Reply. Arthritis Care Res (Hoboken) 2023; 75:2223-2224. [PMID: 36530033 PMCID: PMC10277217 DOI: 10.1002/acr.25075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Huifeng Yun
- University of Alabama at Birmingham, Department of Epidemiology
| | | | | | - Leslie R. Harrold
- CorEvitas LLC
- University of Massachusetts Medical School, Department of Medicine
| | - Jeffrey R Curtis
- University of Alabama at Birmingham, Division of Immunology and Rheumatology
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Sparks JA, Harrold LR, Simon TA, Wittstock K, Kelly S, Lozenski K, Khaychuk V, Michaud K. Comparative effectiveness of treatments for rheumatoid arthritis in clinical practice: A systematic review. Semin Arthritis Rheum 2023; 62:152249. [PMID: 37573754 DOI: 10.1016/j.semarthrit.2023.152249] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess real-world comparative effectiveness studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in adults with rheumatoid arthritis (RA) through a systematic review. METHODS We searched Medline for journal articles (2001-2021) and Embase® for abstracts presented at the European Alliance of Associations for Rheumatology and American College of Rheumatology (ACR) 2020 and 2021 annual meetings on non-randomized studies comparing the effectiveness of b/tsDMARDs using ACR-recommended disease activity measures, measures of functional status, and patient-reported outcomes (HAQ, PROMIS PF, patient pain, Patient and Physician Global Assessment of disease activity). Methodological heterogeneity between studies precluded meta-analyses. Risk of bias was assessed using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions-I tool. RESULTS Of 1283 records screened, 68 were selected for data extraction, of which 1 was excluded due to critical risk of bias. Most studies were multicenter observational cohort/registry studies (n = 60) and were published between 2011 and 2021 (n = 60). Mean or median reported RA duration was between 6 and 15 years. Disease Activity Score in 28 joints (46 studies), Clinical Disease Activity Index (37 studies), and Health Assessment Questionnaire-Disability Index (32 studies) were the most common outcomes used in clinical practice, with regional differences identified. The most common comparison was between tumor necrosis factor inhibitors (TNFis) and non-TNFi bDMARDs (35 studies). There were no evident differences between b/tsDMARDs in clinical effectiveness. CONCLUSION This systematic review summarizing real-world evidence from a very large number of global studies found there are many effective options for the treatment of RA, but relatively less evidence to support the use of any one b/tsDMARD or drug class over another. Treatment for patients with RA should be tailored to suit individual clinical profiles. Further research is needed to identify whether specific patient subgroups may benefit from specific drug classes.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA; University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA; FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
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Hsiao B, Downs JS, Lanyon M, Blalock SJ, Curtis JR, Harrold LR, Nowell WB, Wiedmeyer C, Venkatachalam S, Patterson MT, Gavigan K, Stradford L, Ali D, Fraenkel L. Understanding Heterogeneity in Patients' Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis. BMJ Open 2023; 13:e070848. [PMID: 37666546 PMCID: PMC10481841 DOI: 10.1136/bmjopen-2022-070848] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/10/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients' conceptualisation of RA treatment to inform interventions improving TTT uptake. DESIGN Eligible participants recruited from an online research registry rated 56 items (on 5-point scales) reflecting concepts raised from patient interviews. Using items describing adhering to physician recommendations to create a binary criterion variable for medication adherence, we conducted a principal components analysis on the remaining items using Varimax rotation, describing how these factors predict adherence over and above demographic characteristics. We further use optimal sets in regression to identify the individual concepts that are most predictive of medication adherence. RESULTS We found significant heterogeneity in patients' conceptualisation of RA treatment among 621 persons with RA. A scree plot revealed a four-factor solution explained 38.4% of the variance. The four factors expected to facilitate TTT uptake were (% variance explained): (1) Access to high quality care and support (11.3%); (2) low decisional conflict related to changing disease-modifying antirheumatic drugs (DMARDs) (10.1%); (3) endorsement of a favourable DMARD risk/benefit ratio (9.9%); and (4) confidence that testing reflects disease activity (7.2%). These factors account for 13.8% of the variance in full medication adherence, fully explaining the only significant demographic predictor, age of the patient. The individual items most predictive of poor adherence centre on the lack of effective patient-physician communication, specifically insufficient access to information from rheumatologists, along with the need to seek information elsewhere. CONCLUSION Patients' conceptualisation of RA treatment varies; however, almost all patients have difficulty escalating DMARDs, even with access to quality information and an understanding of the benefits of TTT. Tailored interventions are needed to address patient hesitancy to escalate DMARDs.
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Affiliation(s)
- Betty Hsiao
- Yale University, New Haven, Connecticut, USA
| | - Julie S Downs
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Mandy Lanyon
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Susan J Blalock
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey R Curtis
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, New York, USA
| | - Laura Stradford
- Global Healthy Living Foundation, Upper Nyack, New York, USA
| | - Danielle Ali
- Global Healthy Living Foundation, Upper Nyack, New York, USA
| | - Liana Fraenkel
- Yale University, New Haven, Connecticut, USA
- Berkshire Medical Center, Pittsfield, Massachusetts, USA
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Yun H, Chen L, Roy JA, Greenberg J, Harrold LR, George MD, Curtis JR. Rheumatoid Arthritis Disease Activity and Hospitalized Infection in a Large US Registry. Arthritis Care Res (Hoboken) 2023; 75:1639-1647. [PMID: 35866713 PMCID: PMC10277216 DOI: 10.1002/acr.24984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/30/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The association between disease activity and infection risk among patients with rheumatoid arthritis (RA) is not clear, and it is challenging to determine because of confounding due to the effects of RA treatments and comorbidities. METHODS Using patients with RA in the CorEvitas registry with Medicare coverage in 2006-2019, we identified eligible patients who had at least 1 visit with moderate disease activity based on the Clinical Disease Activity Index (CDAI; CDAI >10 and ≤22). Follow-up started at the subsequent CorEvitas visit. Hospitalized infection during follow-up was assessed in linked Medicare data. We calculated the incidence rate of hospitalized infection for patients in remission, and low and moderate disease activity, and estimated the effect of time-varying CDAI on hospitalized infection by controlling for baseline and time-dependent confounders using marginal structural models (MSMs). RESULTS A total of 3,254 patients with RA were eligible for analysis, among which 529 hospitalized infections were identified during follow-up. The crude incidence of hospitalized infection was 3.8 per 100 person-years for patients in remission, 6.6 for low disease activity, and 8.0 for moderate disease activity. Using MSMs and compared with being in remission, the hazard ratio of hospitalized infection associated with low disease activity was 1.60 (95% confidence interval [95% CI] 1.13-2.28) and with moderate disease activity was 1.83 (95% CI 1.30-2.64). CONCLUSION The risk of hospitalized infection was higher for patients with RA in low or moderate disease activity than for those in remission after accounting for the interplay of disease activity, RA treatments, treatment switching, and other potential confounders.
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Affiliation(s)
- Huifeng Yun
- University of Alabama at Birmingham, Department of Epidemiology
| | - Lang Chen
- University of Alabama at Birmingham, Division of Immunology and Rheumatology
| | - Jason A Roy
- Rutgers University, Department of Biostatistics and Epidemiology
| | | | - Leslie R. Harrold
- CorEvitas LLC
- University of Massachusetts Medical School, Department of Medicine
| | | | - Jeffrey R Curtis
- University of Alabama at Birmingham, Division of Immunology and Rheumatology
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Yoshida K, Harrold LR, Middaugh N, Guan H, Stryker S, Karis E, Solomon DH. Examining the potential direct cardiovascular benefit of tumor-necrosis factor inhibitor in rheumatoid arthritis: Natural and controlled direct effect analyses. Pharmacoepidemiol Drug Saf 2023; 32:407-415. [PMID: 36129396 DOI: 10.1002/pds.5546] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/PURPOSE Tumor necrosis factor inhibitors (TNFi) may have a direct benefit on cardiovascular (CV) disease beyond reducing rheumatoid arthritis (RA) disease activity measured by the Clinical Disease Activity Index (CDAI). METHODS We compared TNFi initiators and methotrexate (MTX) monotherapy initiators from the CorEvitas RA registry. Two approaches to the "direct effect" of TNFi beyond CDAI were used. In the natural direct effect (NDE) analysis, the potential CV benefit of TNFi was partitioned into NDE and the natural indirect effect (NIE) mediated by CDAI during the first 6 months. We also estimated the controlled direct effects (CDE), corresponding to the direct benefit of TNFi when CDAI trajectories were hypothetically equalized between the initiators of TNFi and MTX monotherapy at a constant value. Estimates were given on the hazard ratio scale. RESULTS We identified 5764 initiators of TNFi and 3588 initiators of MTX monotherapy. TNFi initiators were younger (58 vs. 64 years) with a shorter disease duration. Our total effect estimates (TNFi vs. MTX [reference]) were protective in direction (0.76-0.91). The NDE estimate was 0.76 [95% confidence interval (CI) 0.59, 0.98], whereas the NIE estimate was 1.00 [95%CI 1.00, 1.00]. In the CDE analyses accounting for longitudinal CDAI, the CDE estimates was 1.27 [95%CI 0.60, 2.69]. CONCLUSIONS We could not convincingly demonstrate a direct benefit of TNFi outside its impact on CDAI. At present, the emphasis should be on the stringent control of RA disease activity, a known important CV risk factor, regardless of medication choice.
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Affiliation(s)
- Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- CorEvitas, LLC, Waltham, Massachusetts, USA
| | | | - Hongshu Guan
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Harrold LR, Wittstock K, Kelly S, Han X, Shan Y, Guo L, Moore PC, Khaychuk V. Comparative Effectiveness of Abatacept vs. Tofacitinib in Rheumatoid Arthritis Patients who are CCP. Rheumatol Ther 2023; 10:575-587. [PMID: 36749478 PMCID: PMC10140197 DOI: 10.1007/s40744-022-00523-z] [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: 09/08/2022] [Accepted: 12/13/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Currently there is limited data to drive clinical decision making regarding the choice of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARD); thus, head-to-head comparisons are needed to help guide prescribing. In recent years, significant advancements have helped clarify the mechanistic basis of the clinical associations of autoantibodies in rheumatoid arthritis (RA). This study evaluated the effectiveness of abatacept versus tofacitinib in anti-cyclic citrullinated peptide (CCP+) patients with rheumatoid arthritis (RA). METHODS CorEvitas (formerly known as CORRONA) Registry patients aged ≥ 18 years, who were CCP+ before initiating abatacept or tofacitinib (December 2012 onwards through October 2019), had 6-month follow-up data (baseline and 6-month Clinical Disease Activity Index [CDAI]), and were not in remission at index were included. Patients were frequency matched 1:1 by prior biologic use before propensity score matching (PSM). Primary (mean change [D] in CDAI) and secondary outcomes 6 months after index were compared using mixed-effects models adjusted for variables that remained unbalanced after PSM. RESULTS Following PSM, most baseline characteristics for 291 patient pairs were well balanced between treatments, although fewer patients initiating abatacept versus tofacitinib received prior non-TNFi biologic DMARDs, and patients initiating abatacept versus tofacitinib had a higher physician global assessment score, patient-reported fatigue, and modified Health Assessment Questionnaire (mHAQ). In adjusted analyses, there were no significant differences in mean [D] from baseline in CDAI at 6 months with abatacept versus tofacitinib (P = 0.936). Patients naïve for b/tsDMARDs initiating abatacept had a numerically greater mean [D] in CDAI at 6 months versus tofacitinib, although this difference was not statistically significant (P = 0.662). There were no significant differences for any secondary outcomes. CONCLUSIONS In adjusted analyses, CCP+ patients with RA initiating treatment with abatacept versus tofacitinib did not show a statistically significant difference in reducing disease activity or improving patient-reported outcomes.
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Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, 1440 Main Street, Waltham, MA, 02451, USA. .,University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | - Xue Han
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Ying Shan
- CorEvitas, LLC, 1440 Main Street, Waltham, MA, 02451, USA
| | - Lin Guo
- CorEvitas, LLC, 1440 Main Street, Waltham, MA, 02451, USA
| | - Page C Moore
- CorEvitas, LLC, 1440 Main Street, Waltham, MA, 02451, USA
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12
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Baker JF, Reed G, Poudel DR, Harrold LR, Kremer JM. Obesity and Response to Advanced Therapies in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2022; 74:1909-1916. [PMID: 35143117 DOI: 10.1002/acr.24867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We performed a study of tumor necrosis factor inhibitors (TNFi) compared to non-TNFi biologic therapies in rheumatoid arthritis to test whether body mass index (BMI) modified the effect of each therapy. METHODS We utilized data from CorEvitas. We studied 3 clinical outcomes based on the Clinical Disease Activity Index (CDAI) at 6 months from therapy initiation: 1) achievement of low disease activity (LDA); 2) a change as large as the minimum clinically important difference (MCID); and 3) the absolute change. We categorized BMI and utilized restricted cubic splines to consider nonlinear associations. We used linear and logistic regression to evaluate associations with response, adjusting for confounders. To determine if comparative effectiveness of therapy varied by BMI, we tested for interactions between BMI and class of therapy. RESULTS The sample included 2,891 TNFi and 3,010 non-TNFi initiators. Among all initiators, those with severe obesity experienced lower odds of achieving LDA or MCID and less improvement in CDAI score, although associations were attenuated with adjustment. Low BMI was associated with reduced response rates in adjusted models including lower odds of LDA (odds ratio 0.32 [95% confidence interval (95% CI) 0.15, 0.71], P = 0.005). Analyses stratified by TNFi and non-TNFi therapies demonstrated no differences in clinical response rates for TNFi versus non-TNFi across BMI categories (all P for interaction >0.05). Estimates for non-TNFi biologics fit within the 95% CI for TNFi. CONCLUSION This study observed lower response rates among obese and underweight patients and no evidence of a superior effect of non-TNFi therapy over TNFi therapy in particular BMI categories.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | - George Reed
- Corrona Research Foundation, Albany, New York
| | | | - Leslie R Harrold
- Corrona Research Foundation, Albany, New York, and University of Massachusetts Medical School, Worcester
| | - Joel M Kremer
- Corrona Research Foundation and Albany Medical College and the Center for Rheumatology, Albany, New York
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13
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Hsiao B, Downs J, Lanyon M, Blalock SJ, Curtis JR, Harrold LR, Nowell WB, Wiedmeyer C, Venkatachalam S, Fraenkel L. Rheumatologist and Patient Mental Models for Treatment of Rheumatoid Arthritis Help Explain Low Treat-to-Target Rates. ACR Open Rheumatol 2022; 4:700-710. [PMID: 35665497 PMCID: PMC9374053 DOI: 10.1002/acr2.11443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/04/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Despite proven benefits, less than half of patients with rheumatoid arthritis (RA) are treated using a treat-to-target (TTT) strategy. Our objective was to identify critical discrepancies between rheumatologist and patient mental models related to the treatment of RA to inform interventions designed to increase implementation of TTT. METHODS We developed rheumatologist and patient mental models using the Mental Models Approach to Risk Communication. We conducted semistructured interviews to elicit views related to RA treatment decisions with 14 rheumatologists and 30 patients with RA. We also included responses (n = 284) to an open-ended question on a survey fielded to augment qualitative descriptions from the interviews. Interviews were transcribed and coded independently by two members of the research team. RESULTS Rheumatologist and patient mental models for RA treatment are significantly more complex than the TTT model. Both consider domains (system factors and patient readiness) outside of disease activity measurement, target setting, and risk versus benefit assessment in their decision-making. Furthermore, specific factors were found to be unique to each model. For example, the physician model stresses the importance of evaluating disease activity over time and patient adherence. In contrast, patients discussed the impact of chronic disease weariness, medication-related fatigue, the importance of feeling adequately informed, and stress associated with changing medications. CONCLUSION We found several discrepancies primarily related to information gaps and differences in how patients and physicians value trade-offs that can serve as specific targets to improve patient-physician communication and ultimately inform interventions to improve uptake of TTT.
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Affiliation(s)
| | - Julie Downs
- Carnegie Mellon UniversityPittsburghPennsylvania
| | - Mandy Lanyon
- Carnegie Mellon UniversityPittsburghPennsylvania
| | | | | | | | | | | | | | - Liana Fraenkel
- Yale University, New Haven Connecticut, and Berkshire Medical CenterPittsfieldMassachusetts
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14
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Yoshida K, Harrold LR, Middaugh N, Guan H, Stryker S, Karis E, Solomon DH. Time-Varying Association of Rheumatoid Arthritis Disease Activity to Subsequent Cardiovascular Risk. ACR Open Rheumatol 2022; 4:587-595. [PMID: 35403370 PMCID: PMC9274374 DOI: 10.1002/acr2.11432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective It is unknown how the relationship between disease activity in rheumatoid arthritis (RA) and cardiovascular (CV) events may change over time. We examined the potentially time‐varying association of RA disease activity to CV events. Methods We used the CorEvitas prevalent RA registry. The Clinical Disease Activity Index (CDAI) score category, averaged within each 6‐month window since enrollment, was the exposure, and the outcome was major adverse CV events (MACEs). We used marginal structural models to estimate the hazard ratio (HR), comparing each CDAI score category with remission, allowing for differential association over time. We predicted MACE‐free survival under several CDAI score scenarios. Results We found 44,816 eligible patients (77% female; mean age 58 years) with a crude event rate of 5.3/1000 person‐years (median follow‐up 3.4 years). The strongest association between higher CDAI score and MACEs was observed during the first 6 months of enrollment (HR for CDAI score low 2.29 [95% CI: 1.21‐4.36], moderate 2.81 [95% CI: 1.46‐5.43], and high 2.99 [95% CI: 1.48‐6.02]). These estimates gradually diminished; by year 5, the HRs were 1.00 (95% CI: 0.49‐2.05) for low, 1.18 (95% CI: 0.51‐2.71) for moderate, and 1.04 (95% CI: 0.45‐2.40) for high CDAI score. Predicted MACE‐free survival suggested a potential decrease in MACEs with a hypothetical earlier transition to remission. Conclusion The association of higher disease activity with CV events may be stronger earlier in the disease course of RA. Interventional studies may be warranted to precisely determine the effect of disease activity suppression on CV events in RA.
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Affiliation(s)
- Kazuki Yoshida
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and CorEvitas, LLC, Waltham, Massachusetts
| | | | - Hongshu Guan
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Daniel H Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Harrold LR, Connolly SE, Wittstock K, Zhuo J, Kelly S, Lehman T, Shan Y, Rebello S, Guo L, Khaychuk V. Baseline Anti-Citrullinated Protein Antibody Status and Response to Abatacept or Non-TNFi Biologic/Targeted-Synthetic DMARDs: US Observational Study of Patients with RA. Rheumatol Ther 2022; 9:465-480. [PMID: 34940957 PMCID: PMC8964884 DOI: 10.1007/s40744-021-00401-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) may respond to treatments differently based on their underlying serology and biomarker status, but real-world data comparing treatment responses to abatacept versus other non-TNFi biologic or targeted-synthetic DMARDs by anti-citrullinated protein antibody (ACPA) status remain limited. We assessed the association between ACPA status and response to treatment in patients with RA. METHODS Adults from CorEvitas' RA Registry were identified who initiated abatacept, rituximab, tocilizumab, or tofacitinib, and had ACPA measured at/prior to treatment initiation and at the 6-month follow-up visit. Three cohorts were included: abatacept/rituximab (2006-2019), abatacept/tocilizumab (2010-2019), and abatacept/tofacitinib (2012-2019). Patient characteristics at initiation were compared by ACPA status (positive [+], anti-cyclic citrullinated peptide-2 [anti-CCP2] ≥ 20 U/ml; negative [-], anti-CCP2 < 20 U/ml). Outcomes over 6 months: changes in Clinical Disease Activity Index (CDAI), modified Health Assessment Questionnaire (mHAQ), patient global assessment (PGA) scores, and proportion of patients achieving a clinical response. Adjusted mean differences and odds ratios were estimated using mixed-effects linear regression models. RESULTS Overall, 982 abatacept, 246 rituximab, 404 tocilizumab, and 429 tofacitinib initiators were identified. ACPA+ (vs. ACPA-) patients had longer disease duration and more erosive disease. During most time periods adjusted mean changes in CDAI, mHAQ, and PGA scores and the proportion of patients achieving a clinical response were significantly higher for ACPA+ versus ACPA- patients initiating abatacept. Adjusted mean change in PGA score and patient fatigue were significantly higher for ACPA+ versus ACPA- patients initiating rituximab. No significant differences were seen by ACPA status for patients initiating tocilizumab or tofacitinib. CONCLUSIONS Patients who initiated abatacept or rituximab and were ACPA+ had a greater clinical response at 6-month follow-up post index compared to patients who were ACPA- treated with the same biologic.
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Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, Waltham, MA, USA.
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | - Joe Zhuo
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Ying Shan
- Department of Biostatistics, CorEvitas, LLC, Waltham, MA, USA
| | | | - Lin Guo
- Department of Biostatistics, CorEvitas, LLC, Waltham, MA, USA
| | - Vadim Khaychuk
- US Medical Immunology and Fibrosis, Bristol Myers Squibb, Princeton, NJ, USA
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16
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Danila MI, Chen L, Ruderman EM, Owensby JK, O'Beirne R, Melnick JA, Harrold LR, Curtis D, Nowell WB, Curtis JR. Evaluation of an Intervention to Support Patient-Rheumatologist Conversations About Escalating Treatment in Patients with Rheumatoid Arthritis: A Proof-of-Principle Study. ACR Open Rheumatol 2021; 4:279-287. [PMID: 34962093 PMCID: PMC8992469 DOI: 10.1002/acr2.11393] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study’s objective was to test whether an online video intervention discussing appropriate treatment escalation improves willingness to change treatment in people living with rheumatoid arthritis (RA). Methods We conducted a controlled, randomized trial among patients with RA enrolled in ArthritisPower, a United States patient registry. We recruited participants by email and surveyed their assessment of disease activity (patient global), satisfaction with disease control (patient acceptable symptom state), attitudes about RA medications, decisional conflict (decisional conflict scale), and willingness to modify RA treatment (choice predisposition scale, higher scores are better) if or when recommended by their rheumatologist. Intervention groups watched educational videos relevant to a treat‐to‐target (T2T) strategy, whereas control groups viewed vaccination‐related videos as an “attention control.” We compared the between‐group difference in patients’ willingness to modify RA treatment (primary outcome) and difference in decisional conflict about changing RA treatment (secondary outcome) after watching the videos using t tests. Results Participants with self‐reported RA (n = 208) were 90% White and 90% women, with a mean (standard deviation) age of 50 (11) years, and 52% reported familiarity with the RA T2T strategy. We found a significant improvement in between‐group difference in willingness to change RA treatment among intervention versus control participants (0.49 [95% confidence interval 0.09‐0.88], P = 0.02). The effect size (Glass’s delta) for the intervention was 0.48. Decisional conflict about treatment change decreased, but the between‐group difference was not significant. Conclusion This novel educational patient‐directed intervention discussing appropriate treatment escalation was associated with improved willingness to change RA treatment if or when recommended by a rheumatologist. Further studies should evaluate whether this change in patients’ predisposition translates into actual treatment escalation.
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Affiliation(s)
- Maria I Danila
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Lang Chen
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Ronan O'Beirne
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, New York
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17
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Curtis JR, Palmer JL, Reed GW, Greenberg J, Pappas DA, Harrold LR, Kremer JM. Real-World Outcomes Associated With Methotrexate, Sulfasalazine, and Hydroxychloroquine Triple Therapy Versus Tumor Necrosis Factor Inhibitor/Methotrexate Combination Therapy in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73:1114-1124. [PMID: 32374918 DOI: 10.1002/acr.24253] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Though randomized controlled trials have demonstrated relatively comparable clinical outcomes with triple therapy (methotrexate [MTX], sulfasalazine [SSZ], and hydroxychloroquine [HCQ]) compared to combination therapy (tumor necrosis factor inhibitor [TNFi] and MTX), real-world experiences comparing these strategies have not been well studied. METHODS We evaluated the clinical effectiveness and effects of medication discontinuation of triple therapy with MTX/SSZ/HCQ versus combination therapy with TNFi/MTX in rheumatoid arthritis (RA) patients enrolled in the Corrona RA Drug Safety & Effectiveness Registry. Propensity score matching was used to match patients up to a ratio of 1:3 to adjust for imbalances between treatment groups, with stratification performed according to biologics-naive or biologics-exposed status of study participants. RESULTS Patients eligible for analysis in this study included biologics-naive RA patients (3,926 who received combination therapy with TNFi/MTX and 262 who received triple therapy with MTX/SSZ/HCQ) and biologics-exposed RA patients (3,365 who received combination therapy with TNFi/MTX and 130 patients who received triple therapy with MTX/SSZ/HCQ). Before propensity score matching, numerous factors were imbalanced between the treatment groups, with triple therapy patients generally being older, having a longer disease duration of RA and lower RA disease activity, and more likely having a history of malignancy and other comorbidities. After matching, almost all (93-98%) triple therapy patients could be matched to TNFi/MTX therapy patients, and cohort characteristics were generally well balanced. Discontinuation of medication was greater in triple therapy patients referent to TNFi/MTX therapy patients (adjusted hazard ratio [HR] of 2.17 [95% confidence interval 1.63-2.88] in the biologics-naive group; adjusted HR of 1.51 [95% confidence interval 1.06-2.15] in the biologics-exposed group). At 6 months, the proportion of biologics-naive patients attaining low disease activity was significantly greater in the TNFi/MTX treatment group (49.2% in TNFi/MTX therapy patients versus 33.3% in triple therapy patients), as was the mean change in Clinical Disease Activity Index scores (-9.3 units versus -5.5 [95% confidence interval -1.5, -6.1]). Corresponding results in the biologics-exposed patients numerically favored TNFi/MTX therapy compared to triple therapy but did not reach statistical significance. CONCLUSION Few patients receive triple therapy with MTX/SSZ/HCQ in the US. In the present study, drug persistence and clinical effectiveness outcomes were less favorable in triple therapy patients compared to TNFi/MTX therapy patients.
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Affiliation(s)
| | | | - George W Reed
- University of Massachusetts Medical School, Worcester
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18
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Harrold LR, Bryson J, Lehman T, Zhuo J, Gao S, Han X, Schrader A, Rebello S, Pappas DA, Sommers T, Kremer JM. Association Between Baseline Anti-cyclic Citrullinated Peptide Antibodies and 6-Month Clinical Response Following Abatacept or TNF Inhibitor Treatment: A Real-World Analysis of Biologic-Experienced Patients with RA. Rheumatol Ther 2021; 8:937-953. [PMID: 34047953 PMCID: PMC8217398 DOI: 10.1007/s40744-021-00310-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/28/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with poor prognosis in patients with rheumatoid arthritis (RA). Previous data from randomized controlled trials and clinical practice have shown anti-CCP-positive (+) patients had a better response to treatment with abatacept or tumor necrosis factor inhibitor (TNFi) treatment than those who were anti-CCP negative. This study assessed the association between baseline anti-CCP2 [a surrogate for anti-citrullinated protein antibody (ACPA)] concentration and 6-month treatment responses to abatacept or TNFi in patients with RA. METHODS This real-world analysis included biologic-experienced patients from CERTAIN (Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory CoNditions) who initiated abatacept or TNFi, had prior biologic disease-modifying drug exposure and baseline anti-CCP2 concentration/serostatus and serum samples (baseline and 6 months). Baseline demographics and disease characteristics were compared. Change from baseline at 6 months in Clinical Disease Activity Index (CDAI) score and patient-reported outcomes [PROs: pain, fatigue, patient global assessment (PtGA), modified Health Assessment Questionnaire (mHAQ) score], by baseline anti-CCP2 quartile and binary cut-off (> 10-250 and > 250 U/ml), were evaluated separately in the abatacept and TNFi groups using a linear regression model adjusted for age, sex, CDAI/PROs, comorbidity index, and methotrexate use. RESULTS Included were 138 abatacept and 137 TNFi initiators who were anti-CCP2+. At baseline, there were significant differences between anti-CCP2 quartiles and mean CDAI, swollen joint count 28, C-reactive protein (CRP), Disease Activity Score 28 (CRP), rheumatoid factor (RF), mHAQ and physician global assessment among abatacept initiators, and in mean RF, mHAQ, and PtGA among TNFi initiators. Among abatacept (but not TNFi) initiators, CDAI numerically improved (p = 0.208) and PROs significantly improved (p < 0.05) with increasing baseline anti-CCP2. CONCLUSIONS In patients treated with abatacept, not TNFi, higher anti-CCP2 concentrations at baseline were associated with numerically greater improvements in CDAI and significant improvements in PROs after 6 months. CLINICAL TRIAL NUMBER NCT01625650.
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Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, 1440 Main Street, Suite 310, Waltham, MA, 02451, USA.
- University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Joshua Bryson
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ, 08540, USA
| | - Thomas Lehman
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ, 08540, USA
| | - Joe Zhuo
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ, 08540, USA
| | - Sheng Gao
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ, 08540, USA
| | - Xue Han
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ, 08540, USA
| | - Amy Schrader
- CorEvitas, LLC, 1440 Main Street, Suite 310, Waltham, MA, 02451, USA
| | - Sabrina Rebello
- Amyloidosis Research Consortium, 320 Nevada Street, Suite 210, Newton, Massachusetts, 02460, USA
| | - Dimitrios A Pappas
- CorEvitas, LLC, 1440 Main Street, Suite 310, Waltham, MA, 02451, USA
- Department of Medicine, Columbia University, 630 West 168th Street, New York, NY, USA
| | - Tanya Sommers
- CorEvitas, LLC, 1440 Main Street, Suite 310, Waltham, MA, 02451, USA
| | - Joel M Kremer
- Albany Medical College and the Center for Rheumatology, 47 New Scotland Ave, Albany, NY, 12208, USA
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Kremer JM, Pappas DA, Kane K, Greenberg J, Harrold LR, Feathers VL, Shadick N, Weinblatt ME, Reed G. The Clinical Disease Activity Index and the Routine Assessment of Patient Index Data 3 for Achievement of Treatment Strategies. J Rheumatol 2020; 48:1776-1783. [PMID: 33323534 DOI: 10.3899/jrheum.200692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the Clinical Disease Activity Index (CDAI) with the Routine Assessment of Patient Index Data 3 (RAPID3) from 2 large United States registries. METHODS Using a cross section of clinic visits within 2 registries, we determined whether the outcome of each metric would place the patient in remission (REM), low (LDA), moderate (MDA), or high disease activity (HDA) using the CDAI, with the assumption that a patient in MDA or HDA would be a candidate for acceleration of treatment. RESULTS We identified significant disparities between the 2 indices in final disease categorization using each index system. For patients identified in LDA by CDAI, RAPID3 identified 20.4% and 28.3% as LDA in Corrona and the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS), respectively. For patients identified as MDA by CDAI, RAPID3 identified 36.2% and 31.1% as MDA in Corrona and BRASS, respectively, with the greatest disparities within each system identified for LDA and MDA activity by the CDAI (20.4% and 36.2% agreement of RAPID3 with CDAI, respectively, in Corrona and 28.3% and 31.1% agreement in BRASS). Overall comparison between CDAI and RAPID3 in the 4 disease categories resulted in estimated k = 0.285 in both. The RAPID3 scores indicated the potential for treat-to-target acceleration in 34.4% of patients in REM or LDA based on CDAI in Corrona and 27.7% in BRASS, respectively. CONCLUSION The RAPID3, based on patient-reported outcomes, shows differences with CDAI categories of disease activity. The components of CDAI are not highly correlated with RAPID3, except for patient global assessment. These differences could significantly affect the decision to advance treatment when using a treat-to-target regimen.
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Affiliation(s)
- Joel M Kremer
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Dimitrios A Pappas
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Kevin Kane
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Jeffrey Greenberg
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Leslie R Harrold
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Vivi L Feathers
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Nancy Shadick
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - Michael E Weinblatt
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
| | - George Reed
- This study was supported by the Corrona Research Foundation. J.M. Kremer, MD, Albany Medical College and The Center for Rheumatology, Albany, New York; D.A. Pappas, MD, MPH, Columbia University, New York, New York, and Corrona, LLC, Waltham, Massachusetts; K. Kane, MS, G. Reed, PhD, University of Massachusetts Medical School, Worcester, Massachusetts; J. Greenberg, MD, MPH, Corrona, LLC, Waltham, Massachusetts, and New York School of Medicine, New York, New York; L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; V.L. Feathers, MS, N. Shadick, MD, MPH, M.E. Weinblatt, MD, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. The authors declare no conflicts of interest. Address correspondence to Dr. J.M. Kremer, 9832 Rennes Lane, Delray Beach, FL 33446, USA. . Accepted for publication December 3, 2020
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20
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Ogdie A, Liu M, Glynn M, Emeanuru K, Harrold LR, Richter S, Guerette B, Mease PJ. Descriptive Comparisons of the Effect of Apremilast and Methotrexate Monotherapy in Oligoarticular Psoriatic Arthritis: The Corrona Psoriatic Arthritis/Spondyloarthritis Registry Results. J Rheumatol 2020; 48:693-697. [PMID: 33191289 DOI: 10.3899/jrheum.191209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Therapeutic response was evaluated among new apremilast, methotrexate (MTX), or biologic disease-modifying antirheumatic drug (bDMARD) initiators with oligoarticular psoriatic arthritis (PsA). METHODS Patients with oligoarticular PsA in the Corrona PsA/Spondyloarthritis Registry initiating treatment with apremilast, MTX, or bDMARD, and completing 6-month follow-up were included. RESULTS In total, 150 patients initiated monotherapy (apremilast: n = 34; MTX: n = 15; bDMARD: n = 101). Apremilast initiators had higher baseline disease activity than MTX initiators. At follow-up, apremilast initiators experienced numerically greater disease activity improvements than MTX initiators and similar improvements to bDMARD initiators. CONCLUSION Findings suggest apremilast monotherapy is an effective option for patients with oligoarticular PsA.
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Affiliation(s)
- Alexis Ogdie
- A. Ogdie, MD, Departments of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Mei Liu
- M. Liu, PhD, M. Glynn, MS, K. Emeanuru, MPH, Corrona, LLC, Waltham
| | - Meghan Glynn
- M. Liu, PhD, M. Glynn, MS, K. Emeanuru, MPH, Corrona, LLC, Waltham
| | - Kelechi Emeanuru
- M. Liu, PhD, M. Glynn, MS, K. Emeanuru, MPH, Corrona, LLC, Waltham
| | - Leslie R Harrold
- L.R. Harrold, MD, MPH, Corrona, LLC, Waltham, and Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sven Richter
- S. Richter, MD, B. Guerette, PhD, Global Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Benoit Guerette
- S. Richter, MD, B. Guerette, PhD, Global Medical Affairs, Amgen Inc., Thousand Oaks, California
| | - Philip J Mease
- P.J. Mease, MD, Division of Rheumatology Clinical Research, Swedish Medical Center/Providence St. Joseph Health, and Division of Rheumatology, University of Washington School of Medicine, Seattle, Washington, USA
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21
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Owensby JK, Chen L, O'Beirne R, Ruderman EM, Harrold LR, Melnick JA, Safford MM, Curtis JR, Danila MI. Patient and Rheumatologist Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:933-941. [PMID: 31008566 DOI: 10.1002/acr.23907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify and prioritize patient- and rheumatologist-perceived barriers to achieving disease control. METHODS Patients with rheumatoid arthritis (RA) and rheumatologists from the Corrona registry were invited by e-mail to participate in nominal groups. Two separate lists of barriers were created, 1 from RA patient-only nominal groups and the other from rheumatologist-only nominal groups, and barriers were sorted into themes. Next, using an online survey, a random sample of RA patients from the Corrona registry were asked to rank their top 3 barriers to achieving disease control. RESULTS Four nominal groups totaling 37 RA patients identified patient barriers to achieving control of RA activity that were classified into 17 themes. Three nominal groups totaling 25 rheumatologists identified barriers that were classified into 11 themes. The financial aspects of RA care ranked first for both types of nominal groups, while medication risk aversion ranked second among the perceived barriers of the physician nominal group and third among those of the RA patient nominal group. Among the 450 RA patients surveyed, 77% considered RA a top health priority, and 51% reported being aware of the treat-to-target strategy for RA care; the 3 most important patient-perceived challenges to achieving disease control were RA prognosis uncertainty, medication risk aversion, and the financial/administrative burden associated with RA care. CONCLUSION There are common, potentially modifiable, patient- and rheumatologist-reported barriers to achieving RA disease control, including perceived medication risk aversion, suboptimal treatment adherence, and suboptimal patient-physician communication regarding the benefits of tight control of disease activity in RA. Addressing these obstacles may improve adherence to goal-directed RA care.
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Affiliation(s)
| | | | | | | | - Leslie R Harrold
- University of Massachusetts Medical School, Worchester, Massachusetts
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22
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Harrold LR, Shan Y, Rebello S, Kramer N, Connolly SE, Alemao E, Kelly S, Kremer JM, Rosenstein ED. Disease activity and patient-reported outcomes in patients with rheumatoid arthritis and Sjögren’s syndrome enrolled in a large observational US registry. Rheumatol Int 2020; 40:1239-1248. [PMID: 32449040 PMCID: PMC7316680 DOI: 10.1007/s00296-020-04602-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/13/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
The objective of this study was to compare rheumatoid arthritis (RA) disease activity and patient-reported outcomes (PROs) in a national sample of patients with RA with/without Sjögren’s syndrome (SS). Adults with RA from a large observational US registry (Corrona RA) with known SS status between 22 April 2010 and 31 July 2018 and a visit 12 (± 3) months after index date were identified (n = 36,256/52,757). SS status: determined from a yes/no variable reported at enrolment into the Corrona RA registry and follow-up visits. Index date: date that SS status was recorded (yes/no). Patients received biologic or targeted synthetic disease-modifying antirheumatic drugs as part of standard care. Patients with RA only were followed for ≥ 12 months to confirm the absence of SS. Patients were frequency- and propensity-score matched (PSM) 1:1 and stratified by disease duration and treatment response-associated variables, respectively. Clinical Disease Activity Index (CDAI) and PROs 12 months after index visit were compared in patients with and without SS. Baseline characteristics in 283 pairs of PSM patients were balanced. Mean change in CDAI score was numerically lower in patients with RA and SS than patients with RA only (8.8 vs 9.3). Reductions in PROs of pain, fatigue and stiffness were two- to threefold lower for patients with RA and SS versus RA only. Reductions in RA disease activity and RA-related PROs were lower in patients with RA and SS versus those with RA only. Our data indicate that SS adds to treatment challenges; physicians may wish to consider SS status when managing patients with RA.
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Affiliation(s)
- Leslie R. Harrold
- Corrona, LLC, 1440 Main Street, Suite 310, Waltham, MA 02451 USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Ying Shan
- Corrona, LLC, 1440 Main Street, Suite 310, Waltham, MA 02451 USA
| | - Sabrina Rebello
- Corrona, LLC, 1440 Main Street, Suite 310, Waltham, MA 02451 USA
| | - Neil Kramer
- Institute for Rheumatic & Autoimmune Diseases, Overlook Medical Center, Summit, NJ USA
| | | | | | | | - Joel M. Kremer
- Albany Medical College and the Center for Rheumatology, Albany, NY USA
| | - Elliot D. Rosenstein
- Institute for Rheumatic & Autoimmune Diseases, Overlook Medical Center, Summit, NJ USA
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23
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Harrold LR, Griffith J, Zueger P, Litman HJ, Gershenson B, Islam SS, Barr CJ, Guo D, Fay J, Greenberg JD. Longterm, Real-world Safety of Adalimumab in Rheumatoid Arthritis: Analysis of a Prospective US-based Registry. J Rheumatol 2020; 47:959-967. [PMID: 31371657 DOI: 10.3899/jrheum.190260] [Citation(s) in RCA: 4] [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: 07/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess longterm safety in a US cohort of patients with rheumatoid arthritis (RA) treated with adalimumab (ADA) in real-world clinical care settings. METHODS This observational study analyzed the longterm incidence of safety outcomes among patients with RA initiating ADA, using data from the Corrona RA registry. Patients were adults (≥ 18 yrs) who initiated ADA treatment between January 2008 and June 2017, and who had at least 1 followup visit. RESULTS In total, 2798 ADA initiators were available for analysis, with a mean age of 54.5 years, 77% female, and mean disease duration of 8.3 years. Nearly half (48%) were biologic-naive, and 9% were using prednisone ≥ 10 mg at ADA initiation. The incidence rates per 100 person-years for serious infections, congestive heart failure requiring hospitalization, malignancy (excluding nonmelanoma skin cancer), and all-cause mortality were 1.86, 0.15, 0.64, and 0.33, respectively. The incidence of serious infections was higher in the first year of therapy (3.44, 95% CI 2.45-4.84) than in subsequent years, while other measured adverse effects did not vary substantially by duration of exposure. The median time to ADA discontinuation was 11 months, while the median time to first serious infection among those experiencing a serious infection event was 12 months. CONCLUSION Analysis of longterm data from this prospective real-world registry demonstrated a safety profile consistent with previous studies in patients with RA. This analysis did not identify any new safety signals associated with ADA treatment and provides guidance for physicians prescribing ADA for extended periods.
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Affiliation(s)
- Leslie R Harrold
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA.
| | - Jenny Griffith
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Patrick Zueger
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Heather J Litman
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Bernice Gershenson
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Syed S Islam
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Christine J Barr
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Dianlin Guo
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Jonathan Fay
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
| | - Jeffrey D Greenberg
- From the University of Massachusetts Medical School, Worcester; Corrona LLC, Waltham, Massachusetts; AbbVie, North Chicago, Illinois; New York University School of Medicine, New York, New York, USA
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24
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FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King C, Levy G, Libbey C, Mount D, Pillinger MH, Rosenthal A, Singh JA, Sims JE, Smith BJ, Wenger NS, Sharon Bae S, Danve A, Khanna PP, Kim SC, Lenert A, Poon S, Qasim A, Sehra ST, Sharma TSK, Toprover M, Turgunbaev M, Zeng L, Zhang MA, Turner AS, Neogi T. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken) 2020; 72:744-760. [PMID: 32391934 PMCID: PMC10563586 DOI: 10.1002/acr.24180] [Citation(s) in RCA: 333] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/28/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. CONCLUSION Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.
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Affiliation(s)
- John D. FitzGerald
- University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California
| | | | - Ted Mikuls
- University of Nebraska Medical Center and VA Nebraska–Western Iowa Health Care System, Omaha, Nebraska
| | | | | | | | | | - Leslie R. Harrold
- University of Massachusetts Medical School, Worcester Massachusetts, and Corrona, Waltham, Massachusetts
| | | | | | | | - Caryn Libbey
- Boston University School of Medicine, Boston, Massachusetts
| | - David Mount
- VA Boston Healthcare System, Boston, Massachusetts
| | | | | | - Jasvinder A. Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | | | - Benjamin J. Smith
- Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee
| | | | | | | | - Puja P. Khanna
- University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Seoyoung C. Kim
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Samuel Poon
- US Department of Veterans Affairs, Manchester, New Hampshire
| | - Anila Qasim
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Linan Zeng
- McMaster University, Hamilton, Ontario, Canada
| | - Mary Ann Zhang
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
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25
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FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King C, Levy G, Libbey C, Mount D, Pillinger MH, Rosenthal A, Singh JA, Sims JE, Smith BJ, Wenger NS, Bae SS, Danve A, Khanna PP, Kim SC, Lenert A, Poon S, Qasim A, Sehra ST, Sharma TSK, Toprover M, Turgunbaev M, Zeng L, Zhang MA, Turner AS, Neogi T. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol 2020; 72:879-895. [PMID: 32390306 DOI: 10.1002/art.41247] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/28/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide guidance for the management of gout, including indications for and optimal use of urate-lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. METHODS Fifty-seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta-analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. RESULTS Forty-two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3-6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. CONCLUSION Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.
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Affiliation(s)
- John D FitzGerald
- University of California, Los Angeles and VA Greater Los Angeles Health Care System, Los Angeles, California
| | | | - Ted Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | | | | | - Aryeh M Abeles
- New York University School of Medicine, New York City, New York
| | | | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester Massachusetts, and Corrona, Waltham, Massachusetts
| | | | | | | | - Caryn Libbey
- Boston University School of Medicine, Boston, Massachusetts
| | - David Mount
- VA Boston Healthcare System, Boston, Massachusetts
| | | | | | - Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham
| | | | - Benjamin J Smith
- Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee
| | | | | | | | - Puja P Khanna
- University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor
| | - Seoyoung C Kim
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Samuel Poon
- US Department of Veterans Affairs, Manchester, New Hampshire
| | - Anila Qasim
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Linan Zeng
- McMaster University, Hamilton, Ontario, Canada
| | - Mary Ann Zhang
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
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Van Voorhees AS, Mason MA, Harrold LR, Guo N, Guana A, Tian H, Herrera V, Strober BE. Characterization of insufficient responders to ustekinumab in patients with moderate-to-severe psoriasis in the US Corrona Psoriasis Registry. J DERMATOL TREAT 2020; 32:907-915. [PMID: 32027197 DOI: 10.1080/09546634.2020.1720586] [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] [Indexed: 10/25/2022]
Abstract
Objective: Biologic therapies have revolutionized the management of moderate-to-severe psoriasis; however, there are a limited number of US real-world studies characterizing patients based on response to these treatments. This study examined characteristics at enrollment and change in outcomes of US patients with moderate-to-severe psoriasis who achieved insufficient responses with ustekinumab.Methods: This study included patients enrolled in the Corrona Psoriasis Registry from April 2015 to June 2018 who initiated ustekinumab at enrollment and who were stratified based on achievement of psoriasis body surface area improving to <3% or by 75% from enrollment to the 6-month follow-up visit (response vs insufficient response). Patient demographics and disease characteristics were described at enrollment, and changes in outcomes were assessed at 6-month follow-up for ustekinumab responders and insufficient responders.Results: Of the 178 patients who initiated ustekinumab in the Corrona Psoriasis Registry and had ≥1 follow-up visit, 99 (55.6%) were classified as responders at the 6-month follow-up visit. Logistic regression modeling showed that increasing age was significantly associated with a decreased likelihood of achieving a response (OR, 0.981 [95%CI, 0.962-0.999]; p = .049).Conclusions: These findings may help dermatologists characterize patients with moderate-to-severe psoriasis who have inadequate responses to biologic treatments.
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Affiliation(s)
| | | | - Leslie R Harrold
- Corrona, LLC, Waltham, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Adriana Guana
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Haijun Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Vivian Herrera
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Bruce E Strober
- University of Connecticut Health Center, Farmington, CT, USA.,Probity Medical Research, Waterloo, Ontario, Canada
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Harrold LR, Shan Y, Connolly SE, Alemao E, Rebello S, Guo L, Kremer JM. Association among anti-citrullinated protein antibody status, erosive disease and healthcare resource utilization in patients with rheumatoid arthritis. Curr Med Res Opin 2020; 36:337-342. [PMID: 31612736 DOI: 10.1080/03007995.2019.1680354] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To characterize the rate of healthcare resource utilization (HCRU) between anti-cyclic citrullinated peptide (CCP; a surrogate for anti-citrullinated protein antibodies [ACPAs]) positive (+) patients with rheumatoid arthritis (RA), either with or without erosions, who initiated biologic disease-modifying antirheumatic drug (bDMARD) treatment.Methods: Data from the Corrona RA registry, a prospective registry of adult patients with RA from 177 sites across 42 states in the US, were analyzed. Annual rates of HCRU (measured based on rates of all-cause hospitalization, joint surgery, imaging procedures and use of assistive devices) were estimated in anti-CCP + patients with and without erosions following bDMARD initiation using a Poisson regression model.Results: Among the 3333 patients with known anti-CCP and erosion status and 12-month post-bDMARD follow-up information in the Corrona registry, 2047 were anti-CCP + and included in this analysis; 868 with and 1179 without erosions. Baseline characteristics were generally well balanced between patients with and without erosions; however, those with erosions had a longer mean RA duration and a higher prior DMARD use. Over 12 months, among anti-CCP + patients, those with erosions had significantly higher rates of all HCRU, except joint surgery, than those without erosions. Age-adjusted risk ratios (95% confidence interval) were as follows: all-cause hospitalization, 1.47 (1.14, 1.90); all-cause imaging, 1.25 (1.03, 1.53); and assistive device use 1.12 (1.00, 1.25). The rate of joint surgery visits was also numerically higher in patients with versus without erosion.Conclusions: ACPA seropositivity with erosive disease was associated with higher rates of HCRU compared with seropositivity without erosions. These findings suggest that providers may want to manage anti-CCP + patients aggressively to achieve better disease control to prevent the development of erosions and the associated increase in HCRU.
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Affiliation(s)
| | | | | | - Evo Alemao
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Lin Guo
- Corrona, LLC, Waltham, MA, USA
| | - Joel M Kremer
- Albany Medical College and The Center for Rheumatology, Albany, NY, USA
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Bursill D, Taylor WJ, Terkeltaub R, Kuwabara M, Merriman TR, Grainger R, Pineda C, Louthrenoo W, Edwards NL, Andrés M, Vargas-Santos AB, Roddy E, Pascart T, Lin CT, Perez-Ruiz F, Tedeschi SK, Kim SC, Harrold LR, McCarthy G, Kumar N, Chapman PT, Tausche AK, Vazquez-Mellado J, Gutierrez M, da Rocha Castelar-Pinheiro G, Richette P, Pascual E, Fisher MC, Burgos-Vargas R, Robinson PC, Singh JA, Jansen TL, Saag KG, Slot O, Uhlig T, Solomon DH, Keenan RT, Scire CA, Biernat-Kaluza E, Dehlin M, Nuki G, Schlesinger N, Janssen M, Stamp LK, Sivera F, Reginato AM, Jacobsson L, Lioté F, Ea HK, Rosenthal A, Bardin T, Choi HK, Hershfield MS, Czegley C, Choi SJ, Dalbeth N. Gout, Hyperuricemia, and Crystal-Associated Disease Network Consensus Statement Regarding Labels and Definitions for Disease Elements in Gout. Arthritis Care Res (Hoboken) 2019; 71:427-434. [PMID: 29799677 DOI: 10.1002/acr.23607] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/22/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The language currently used to describe gout lacks standardization. The aim of this project was to develop a consensus statement on the labels and definitions used to describe the basic disease elements of gout. METHODS Experts in gout (n = 130) were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach consensus on the labeling and definitions for the basic disease elements of gout. Disease elements and labels in current use were derived from a content analysis of the contemporary medical literature, and the results of this analysis were used for item selection in the Delphi exercise and face-to-face consensus meeting. RESULTS There were 51 respondents to the Delphi exercise and 30 attendees at the face-to-face meeting. Consensus agreement (≥80%) was achieved for the labels of 8 disease elements through the Delphi exercise; the remaining 3 labels reached consensus agreement through the face-to-face consensus meeting. The agreed labels were monosodium urate crystals, urate, hyperuric(a)emia, tophus, subcutaneous tophus, gout flare, intercritical gout, chronic gouty arthritis, imaging evidence of monosodium urate crystal deposition, gouty bone erosion, and podagra. Participants at the face-to-face meeting achieved consensus agreement for the definitions of all 11 elements and a recommendation that the label "chronic gout" should not be used. CONCLUSION Consensus agreement was achieved for the labels and definitions of 11 elements representing the fundamental components of gout etiology, pathophysiology, and clinical presentation. The Gout, Hyperuricemia, and Crystal-Associated Disease Network recommends the use of these labels when describing the basic disease elements of gout.
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Affiliation(s)
- David Bursill
- University of Auckland, Auckland, New Zealand, and Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - William J Taylor
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Robert Terkeltaub
- Veterans Affairs Medical Center and University of California, San Diego
| | - Masanari Kuwabara
- Toranomon Hospital, Tokyo, Japan, and University of Colorado Denver, Aurora
| | | | - Rebecca Grainger
- University of Otago, Wellington, and Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Carlos Pineda
- Instituto Nacional Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | | | - Mariano Andrés
- Hospital Universitario de Alicante and Universidad Miguel Hernández, Alicante, Spain
| | | | | | - Tristan Pascart
- Lille Catholic University and Saint-Philibert Hospital, Lomme, France
| | | | - Fernando Perez-Ruiz
- University of the Basque Country, Biscay, and Cruces University Hospital and Biocruces Health Research Institute, Baracaldo, Spain
| | - Sara K Tedeschi
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Seoyoung C Kim
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Leslie R Harrold
- Corrona, LLC, Waltham, and University of Massachusetts Medical School, Worcester
| | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | | | - Anne-Kathrin Tausche
- University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | | | | | - Pascal Richette
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Eliseo Pascual
- Hospital Universitario de Alicante and Universidad Miguel Hernández, Alicante, Spain
| | - Mark C Fisher
- Harvard Medical School and Massachusetts General Hospital Boston
| | - Ruben Burgos-Vargas
- Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Philip C Robinson
- University of Queensland School of Medicine and Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jasvinder A Singh
- Veterans Affairs Medical Center, Birmingham, and University of Alabama at Birmingham
| | | | | | - Ole Slot
- Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Daniel H Solomon
- Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Carlo Alberto Scire
- University of Ferrara, Ferrara, and Italian Society for Rheumatology, Milan, Italy
| | | | - Mats Dehlin
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | | - Anthony M Reginato
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | | | - Frédéric Lioté
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Hang-Korng Ea
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Ann Rosenthal
- Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee
| | - Thomas Bardin
- Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Hyon K Choi
- Harvard Medical School and Massachusetts General Hospital Boston
| | | | - Christine Czegley
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sung Jae Choi
- University of California, San Diego, and Korea University Ansan Hospital, Ansan, South Korea
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Harrold LR, Patel PA, Griffith J, Litman HJ, Feng H, Schlacher CA, Kremer JM. Assessing disease severity in bio-naïve patients with RA on treatment with csDMARDs: insights from the Corrona Registry. Clin Rheumatol 2019; 39:391-400. [DOI: 10.1007/s10067-019-04727-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 01/28/2023]
Abstract
Abstract
Introduction
This study aimed to characterize disease burden among patients with rheumatoid arthritis (RA) with moderate-to-high disease activity who had received conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) monotherapy for ≥ 6 months but had not advanced to a biologic therapy.
Methods
Patients enrolled in the US Corrona RA Registry between June 1, 2014, and January 30, 2018, with 6 months of continuous csDMARD monotherapy, with moderate-to-high disease activity, who remained biologic naive, and who had ≥ 1 follow-up visit were identified. Disease activity was assessed among patients with a 6-month follow-up visit (± 3 months). Descriptive statistics were used to compare demographics and disease characteristics between patients with or without treatment advancement.
Results
The study included 409 patients with a disease activity assessment at 6 months (mean (SD) age 65.9 (12.6) years; mean duration of csDMARD therapy 407 (221) days). Of those patients, more than half (54%, n = 219) remained in moderate-to-high disease activity. Patients remaining in moderate-to-high vs. remission-to-low disease activity had higher baseline swollen (6.1) and tender joint counts (6.8). Over the 6-month period, treatment advancement occurred in 29% of patients. Those who advanced treatment (n = 118) vs. did not advance treatment (n = 291) were younger, had a shorter duration of RA, had higher disease activity, and reported higher levels of pain and fatigue.
Conclusions
The substantial number of patients with persistent moderate-to-high disease on csDMARDs over a 6-month period and who did not advance treatment indicates that there is considerable need for a treat-to-target approach to care for patients with RA.
Key Points•For patients with RA and an inadequate response to treatment with initial csDMARD monotherapy, guidelines recommend treatment advancement; however, this may not be occurring in real-world clinical settings.•In the current study, a substantial proportion of patients (54%) on csDMARDs had persistent moderate-to-severe disease activity at the 6-month (± 3 months) follow-up visit; however, only 29% of patients had their medication treatment advanced, indicating that there is considerable need for a treat-to-target approach to care for patients with RA.•Patients with younger age, shorter RA duration, and higher disease activity were more likely to have their medication treatment advanced, which suggests that potentially more aggressive treatment of disease activity is needed across the whole RA population.
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Van Voorhees AS, Mason MA, Harrold LR, Guo N, Guana A, Tian H, Herrera V, Strober BE. Characterization of insufficient responders to anti-tumor necrosis factor therapies in patients with moderate to severe psoriasis: real-world data from the US Corrona Psoriasis Registry. J DERMATOL TREAT 2019; 32:302-309. [PMID: 31581919 DOI: 10.1080/09546634.2019.1656797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Biologic therapies have dramatically changed the management of moderate to severe psoriasis; however, few US real-world studies characterize the unmet needs of patients who do not respond to biologic therapies. This study examined the characteristics at enrollment of patients with moderate to severe psoriasis who had insufficient responses to anti-tumor necrosis factor therapies (anti-TNFs). METHODS Patients enrolled in the Corrona Psoriasis Registry from April 2015 to June 2018 who initiated an anti-TNF at enrollment were stratified on the basis of body surface area (BSA) improvement to <3% or a 75% improvement from enrollment to the 6-month follow-up visit (response versus insufficient response). Patient demographics and disease characteristics were described at enrollment, and changes in outcomes were assessed at 6-month follow-up for those who received anti-TNFs. RESULTS Of 180 anti-TNF initiators who had ≥1 follow-up visit, 50.6% were classified as responders. Logistic regression modeling showed that female sex was significantly associated with a decreased likelihood of achieving a response (OR = 0.534, 95% CI = 0.289-0.988, p = .046). CONCLUSION Despite the small sample size and short follow-up period, these findings may help dermatologists to identify patients with moderate to severe psoriasis who have unmet treatment needs.
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Affiliation(s)
| | | | - Leslie R Harrold
- Corrona, LLC, Waltham, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Adriana Guana
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Haijun Tian
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Vivian Herrera
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Bruce E Strober
- University of Connecticut Health Center, Farmington, CT, USA.,Probity Medical Research, Waterloo, Canada
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Bursill D, Taylor WJ, Terkeltaub R, Abhishek A, So AK, Vargas-Santos AB, Gaffo AL, Rosenthal A, Tausche AK, Reginato A, Manger B, Sciré C, Pineda C, van Durme C, Lin CT, Yin C, Albert DA, Biernat-Kaluza E, Roddy E, Pascual E, Becce F, Perez-Ruiz F, Sivera F, Lioté F, Schett G, Nuki G, Filippou G, McCarthy G, da Rocha Castelar Pinheiro G, Ea HK, Tupinambá HDA, Yamanaka H, Choi HK, Mackay J, ODell JR, Vázquez Mellado J, Singh JA, Fitzgerald JD, Jacobsson LTH, Joosten L, Harrold LR, Stamp L, Andrés M, Gutierrez M, Kuwabara M, Dehlin M, Janssen M, Doherty M, Hershfield MS, Pillinger M, Edwards NL, Schlesinger N, Kumar N, Slot O, Ottaviani S, Richette P, MacMullan PA, Chapman PT, Lipsky PE, Robinson P, Khanna PP, Gancheva RN, Grainger R, Johnson RJ, Te Kampe R, Keenan RT, Tedeschi SK, Kim S, Choi SJ, Fields TR, Bardin T, Uhlig T, Jansen T, Merriman T, Pascart T, Neogi T, Klück V, Louthrenoo W, Dalbeth N. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis 2019; 78:1592-1600. [PMID: 31501138 DOI: 10.1136/annrheumdis-2019-215933] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 06/23/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. METHODS A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. RESULTS The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: 'asymptomatic hyperuricaemia', 'asymptomatic monosodium urate crystal deposition', 'asymptomatic hyperuricaemia with monosodium urate crystal deposition', 'gout', 'tophaceous gout', 'erosive gout', 'first gout flare' and 'recurrent gout flares'. There was consensus agreement that the label 'gout' should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). CONCLUSION Consensus agreement has been established for the labels and definitions of eight gout disease states, including 'gout' itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.
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Affiliation(s)
- David Bursill
- Department of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand.,Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Robert Terkeltaub
- Department of Rheumatology, UCSD/ VA Medical Center, San Diego, California, USA
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Alexander K So
- Department of Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland
| | - Ana Beatriz Vargas-Santos
- Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Angelo Lino Gaffo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ann Rosenthal
- Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Translational Research Unit, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Hospital 'Carl Gustav Carus' of the Technical University Dresden, Dresden, Germany
| | - Anthony Reginato
- Division of Rheumatology, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Bernhard Manger
- Rheumatology and Immunology, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carlo Sciré
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Carlos Pineda
- Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Caroline van Durme
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Congcong Yin
- Department of Immunology and Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Daniel Arthur Albert
- Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
| | - Edyta Biernat-Kaluza
- Outpatient Rheumatology Clinic, Nutritional and Lifestyle Medicine Centre, ORLIK, Warsaw, Poland
| | - Edward Roddy
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Eliseo Pascual
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland
| | - Fernando Perez-Ruiz
- Rheumatology Division, Cruces University Hospital, Baracaldo, Spain.,Department of Medicine, University of the Basque Country, Biscay, Spain.,Investigation Group for Arthritis, Biocruces Health Research Institute, Baracaldo, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
| | - Frédéric Lioté
- Department of Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, France.,Department of Rhumatologie, INSERM UMR-1132 and Université Paris Diderot, Paris, France
| | - Georg Schett
- Department of Internal Medicine III, Friedrich-Alexander University Erlangen-Nürnberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - George Nuki
- Insititute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Geraldine McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | | | - Hang-Korng Ea
- Department of Rheumatology, Hôpital Lariboisière, Paris, France
| | | | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan.,School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hyon K Choi
- Section of Rheumatology and Clinical Epidemiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Mackay
- President and CEO, Aristea Therapeutics, San Diego, California, USA
| | - James R ODell
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Janitzia Vázquez Mellado
- Department of Rheumatology, Hospital General de Mexico and Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jasvinder A Singh
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D Fitzgerald
- Department of Medicine/Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Leo Joosten
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Chief Scientific Officer, Corrona, LLC, Southborough, Massachusetts, USA
| | - Lisa Stamp
- Department of Medicine, Otago University, Christchurch, New Zealand
| | - Mariano Andrés
- Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional Rehabilitación, México City, México
| | - Masanari Kuwabara
- Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.,Department of Cardiology, Toranomon Hospital, Minato-ku, Japan
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Michael S Hershfield
- Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Pillinger
- Department of Rheumatology/Medicine, New York University School of Medicine, New York City, New York, USA
| | | | - Naomi Schlesinger
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nitin Kumar
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Detroit, Michigan, USA
| | - Ole Slot
- Department of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Disorders, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Sebastien Ottaviani
- Department of Rheumatology, Bichat-Claude Bernard Hospital, University of Sorbonne Paris Cité, Paris, France
| | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
| | - Paul A MacMullan
- Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
| | - Peter T Chapman
- Department of Rheumatology, Immunology and Allergy, Canterbury District Health Board, Christchurch, New Zealand
| | - Peter E Lipsky
- CEO and CMO, AMPEL BioSolutions, LLC, Charlottesville, Virginia, USA
| | - Philip Robinson
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Puja P Khanna
- Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rada N Gancheva
- Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Sofia, Bulgaria
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, Wellington, New Zealand.,Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA
| | - Ritch Te Kampe
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert T Keenan
- Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sara K Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Arthritis Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seoyoung Kim
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Medical College, Ansan, South Korea
| | - Theodore R Fields
- Weill Cornell Medical College, Hospital for Special Surgery, New York City, New York, USA
| | - Thomas Bardin
- Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tim Jansen
- Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Tony Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Viola Klück
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Solomon DH, Lu B, Yu Z, Corrigan C, Harrold LR, Smolen JS, Fraenkel L, Katz JN, Losina E. Benefits and Sustainability of a Learning Collaborative for Implementation of Treat-to-Target in Rheumatoid Arthritis: Results of a Cluster-Randomized Controlled Phase II Clinical Trial. Arthritis Care Res (Hoboken) 2019; 70:1551-1556. [PMID: 29316341 DOI: 10.1002/acr.23508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We conducted a 2-phase randomized controlled trial of a learning collaborative to facilitate implementation of treat-to-target (T2T) to manage rheumatoid arthritis (RA). We found substantial improvement in implementation of T2T in phase I. Here, we report on a second 9 months (phase II), where we examined the maintenance of response in phase I and predictors of greater improvement in T2T adherence. METHODS We recruited patients from 11 rheumatology sites and randomized them to either receive the learning collaborative during phase I or to a wait-list control group that received the learning collaborative intervention during phase II. The outcome was change in T2T implementation score (0-100, where 100 = best) from pre- to postintervention. The T2T implementation score was defined as a percent of components documented in visit notes. Analyses examined the extent to which the phase-I intervention teams sustained improvement in T2T, as well as predictors of T2T improvement. RESULTS The analysis included 636 RA patients. At baseline, the mean T2T implementation score was 11% in phase I intervention sites and 13% in phase II sites. After the intervention, T2T implementation score improved to 57% in the phase I intervention sites and to 58% in the phase II sites. Intervention sites from phase I sustained the improvement during the phase II (52%). Predictors of greater T2T improvement included having only rheumatologist providers at the site, academic affiliation of the site, having fewer providers per site, and the rheumatologist provider being a trainee. CONCLUSION Improvement in T2T remained relatively stable over a postintervention period.
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Affiliation(s)
| | - Bing Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhi Yu
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Liana Fraenkel
- Yale School of Medicine and VA Connecticut Healthcare System, New Haven
| | | | - Elena Losina
- Brigham and Women's Hospital, Boston, Massachusetts
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Ogdie A, Palmer JL, Greenberg J, Curtis JR, Harrold LR, Solomon DH, Kavanaugh A, Kremer JM, Mease PJ. Predictors of Achieving Remission among Patients with Psoriatic Arthritis Initiating a Tumor Necrosis Factor Inhibitor. J Rheumatol 2019; 46:475-482. [DOI: 10.3899/jrheum.171034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/17/2022]
Abstract
Objective.To examine predictors of remission among patients with psoriatic arthritis (PsA) initiating a tumor necrosis factor (TNF) inhibitor.Methods.Patients with PsA enrolled in the Corrona Registry between 2005 and 2013 were followed from initiation of a TNF inhibitor (TNFi; etanercept, adalimumab, infliximab, certolizumab, or golimumab) to the visit closest to 12 months. Additional inclusion criteria included 3 tender or 3 swollen joints. Outcomes of interest were Clinical Disease Activity Index (CDAI) ≤ 2.8 (remission), low disease activity (LDA; CDAI ≤ 10), change in the modified Health Assessment Questionnaire (mHAQ) ≥ 0.35 and achievement of mHAQ < 0.30. Predictors were measured on or before TNFi initiation. Covariates significant in univariable logistic regression models and ≤ 5% missing values were included in a multivariable model and removed individually until all remaining variables were significant (p < 0.05).Results.Among 1832 TNFi initiations, 774 initiations (624 patients) met inclusion criteria. Median age at initiation was 52 years [interquartile range (IQR) 44–60], 56% were female, median PsA duration was 4 years (IQR 2–11), and median CDAI at baseline was 20 (IQR 14.5–28). Remission was achieved by 14% and LDA (or remission) by 37%. Achieving remission was positively associated with college education (OR 1.88, 95% CI 1.11–3.19) but negatively associated with female sex (0.62, 95% CI 0.40–0.97), obese body mass index (0.51, 95% CI 0.32–0.81), hypertension (0.55, 95% CI 0.32–0.95), previous biologic use (0.41, 95% CI 0.26–0.65), and baseline pain (0.80 per 10 mm visual analog scale, 95% CI 0.73–0.87). Predictors for LDA, mHAQ < 0.30, and mHAQ change were similar.Conclusion.Few patients with PsA in a US-based registry achieved remission by CDAI criteria. Female sex, obesity, comorbidities, and education influence achievement of remission on a TNFi.
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Harrold LR, Reed GW, Best J, Zlotnick S, Kremer JM. Real-world Comparative Effectiveness of Tocilizumab Monotherapy vs. Tumor Necrosis Factor Inhibitors with Methotrexate in Patients with Rheumatoid Arthritis. Rheumatol Ther 2018; 5:507-523. [PMID: 30293218 PMCID: PMC6251839 DOI: 10.1007/s40744-018-0127-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/13/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Controlled clinical studies have shown that the efficacy of tocilizumab (TCZ) monotherapy is superior to that of tumor necrosis factor inhibitor (TNFi) monotherapy and comparable to that of TCZ plus methotrexate (MTX) for the treatment of rheumatoid arthritis (RA). This study compared the real-world effectiveness of TCZ monotherapy vs. TNFis plus MTX in US patients with RA. METHODS TCZ-naïve patients from the Corrona RA registry with prior exposure to ≥ 1 TNFi who initiated TCZ monotherapy or TNFi + MTX were included. Outcomes included mean change in Clinical Disease Activity Index (CDAI), achievement of low disease activity (LDA; CDAI ≤ 10), achievement of modified American College of Rheumatology (mACR) 20/50 responses, and mean change in modified Health Assessment Questionnaire (mHAQ) at 6 months. Patients initiating TNFi + MTX were grouped by MTX dose (≤ 10 mg; > 10 to ≤ 15 mg; > 15 to ≤ 20 mg; > 20 mg); outcomes in each group were compared with TCZ monotherapy using trimmed populations (excluding patients outside the propensity score distribution overlap). RESULTS Patients in all groups experienced improvement in CDAI at 6 months (mean change, - 6.9 to - 9.7), with no significant differences between the TCZ monotherapy and TNFi + MTX groups. Achievement of LDA and mACR responses at 6 months were comparable between the TCZ monotherapy and TNFi + MTX groups; overall, 26.8-38.0% of patients achieved LDA, 24.3-37.6% achieved mACR20 response and 13.2-20.8% achieved mACR50 response. The mean change in mHAQ at 6 months was - 0.1 in all groups. CONCLUSIONS In this real-world population of US patients with RA who had prior TNFi exposure, there was no evidence of a difference in the effectiveness of TCZ monotherapy compared with that of TNFi + MTX, regardless of MTX dose, at 6 months for improving RA disease activity. FUNDING Corrona, LLC. Plain language summary available for this article.
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Affiliation(s)
- Leslie R Harrold
- University of Massachusetts Medical School, Worcester, MA, USA. .,Corrona, LLC, Waltham, MA, USA.
| | - George W Reed
- University of Massachusetts Medical School, Worcester, MA, USA.,Corrona, LLC, Waltham, MA, USA
| | - Jennie Best
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Joel M Kremer
- Corrona, LLC, Waltham, MA, USA.,Albany Medical Center and The Center for Rheumatology, Albany, NY, USA
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Solomon DH, Yu Z, Katz JN, Bitton A, Corrigan C, Fraenkel L, Harrold LR, Smolen JS, Losina E, Lu B. Adverse Events and Resource Use Before and After Treat-to-Target in Rheumatoid Arthritis: A Post Hoc Analysis of a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2018; 71:1243-1248. [PMID: 30221841 DOI: 10.1002/acr.23755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Treat-to-target (TTT) is an accepted paradigm for care of patients with rheumatoid arthritis (RA). Because TTT can be associated with more medication switches, concerns arise regarding whether implementing TTT may increase adverse events and/or resource use. The aim of this study was to examine adverse events and resource use during the preintervention and intervention periods of the TTT intervention trial. METHODS We used data from 6 practices enrolled in an 18-month cluster-randomized controlled trial to compare adverse events and resource use before (months 1-9) and during (months 10-18) a TTT intervention. The outcomes of interest, adverse events and resource use, were based on medical record review of all rheumatology visits for RA patients before and during the intervention. RESULTS We examined records for 321 patients before the intervention and 315 during the intervention. An adverse event was recorded in 10.2% of visits before the intervention and 8.8% of visits during the intervention (P = 0.41). Biologic disease-modifying antirheumatic drugs were taken by 53.6% of patients before the intervention and 49.8% of patients during the intervention (P = 0.73). Rheumatology visits were more frequent before the intervention (mean ± SD 4.0 ± 1.4) than during the intervention (mean ± SD 3.6 ± 1.2; P = 0.02). More visits were accompanied by monitoring laboratory tests before the intervention (90.0%) compared with during the intervention (52.7%; P < 0.001). A greater percentage of visits before the intervention included diagnostic imaging (15.4%) versus during the intervention (8.9%; P < 0.001). CONCLUSION We observed similar rates of adverse events before and during the implementation of TTT for RA. Rheumatology visits, use of laboratory monitoring, and diagnostic imaging did not increase during the TTT intervention.
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Affiliation(s)
| | - Zhi Yu
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Asaf Bitton
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | | | - Elena Losina
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital, Boston, Massachusetts
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Alemao E, Litman HJ, Connolly SE, Kelly S, Hua W, Rosenblatt L, Rebello S, Kremer JM, Harrold LR. Do Poor Prognostic Factors in Rheumatoid Arthritis Affect Treatment Choices and Outcomes? Analysis of a US Rheumatoid Arthritis Registry. J Rheumatol 2018; 45:1353-1360. [PMID: 29961696 DOI: 10.3899/jrheum.171050] [Citation(s) in RCA: 7] [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: 03/21/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To characterize patients with rheumatoid arthritis (RA) by number of poor prognostic factors (PPF: functional limitation, extraarticular disease, seropositivity, erosions) and evaluate treatment acceleration, clinical outcomes, and work status over 12 months by number of PPF. METHODS Using the Corrona RA registry (January 2005-December 2015), biologic-naive patients with diagnosed RA having 12-month (± 3 mos) followup were identified and categorized by PPF (0-1, 2, ≥ 3). Changes in medication, Clinical Disease Activity Index (CDAI), and work status (baseline-12 mos) were evaluated using linear and logistic regression models. RESULTS There were 3458 patients who met the selection criteria: 1489 (43.1%), 1214 (35.1%), and 755 (21.8%) had 0-1, 2, or ≥ 3 PPF, respectively. At baseline, patients with ≥ 3 PPF were older, and had longer RA duration and higher CDAI versus those with 0-1 PPF. In 0-1, 2, and ≥ 3 PPF groups, respectively, 20.9%, 23.2%, and 26.5% of patients received ≥ 1 biologic (p = 0.011). Biologic/targeted synthetic disease-modifying antirheumatic drug (tsDMARD) use was similar in patients with/without PPF (p = 0.57). After adjusting for baseline CDAI, mean (standard error) change in CDAI was -4.95 (0.24), -4.53 (0.27), and -2.52 (0.34) for 0-1, 2, and ≥ 3 PPF groups, respectively. More patients were working at baseline but not at 12-month followup in 2 (13.9%) and ≥ 3 (12.5%) versus 0-1 (7.3%) PPF group. CONCLUSION Despite high disease activity and worse clinical outcomes, number of PPF did not significantly predict biologic/tsDMARD use. This may warrant reconsideration of the importance of PPF in treat-to-target approaches.
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Affiliation(s)
- Evo Alemao
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA. .,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School.
| | - Heather J Litman
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Sean E Connolly
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Sheila Kelly
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Winnie Hua
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Lisa Rosenblatt
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Sabrina Rebello
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Joel M Kremer
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
| | - Leslie R Harrold
- From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA.,E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School
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Yu Z, Lu B, Agosti J, Bitton A, Corrigan C, Fraenkel L, Harrold LR, Losina E, Katz JN, Solomon DH. Implementation of Treat-to-Target for Rheumatoid Arthritis in the US: Analysis of Baseline Data From a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2018; 70:801-806. [PMID: 28834390 DOI: 10.1002/acr.23343] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/15/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE A treat-to-target (TTT) strategy is recommended in rheumatoid arthritis (RA). However, health care providers' adherence to TTT in clinical practice remains unclear. We examined adherence to TTT in RA at US rheumatology sites. METHODS We used baseline information from the randomized controlled Treat-to-Target in RA: Collaboration to Improve Adoption and Adherence trial, which recruited 641 patients from 46 providers practicing at 11 US sites. We obtained data on the implementation of TTT, patient covariates, provider characteristics, and site variables. We examined the implementation of TTT using 4 cardinal features: recording a disease target, recording a disease activity measure, engaging in shared decision-making, and changing treatment if not at disease target. These features were assessed across sites and providers. We calculated a TTT implementation score as the percentage of features noted. We examined the association between patient, provider, and site covariates and TTT implementation score using proportional odds models. RESULTS The implementation of TTT at baseline was suboptimal: 64.3% of visits had none of the TTT components present, 33.1% had 1 component, 2.3% had 2 components, and 0.3% had all components. The implementation of TTT was significantly different across providers and sites (P < 0.0001 for all). In the multivariable model, we observed that more experience as a rheumatologist was associated with a higher implementation score (P = 0.01 for trend). Compared with fellows, providers with >20 years of experience in practice were more likely to have more TTT components recorded (odds ratio 7.68 [95% confidence interval 1.46-40.52]). CONCLUSION We found that adherence to a TTT strategy in RA was suboptimal, and it differed across providers and sites.
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Affiliation(s)
- Zhi Yu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Asaf Bitton
- Brigham and Women's Hospital and Ariadne Labs, Boston, Massachusetts
| | | | - Liana Fraenkel
- Yale School of Medicine and VA Connecticut Healthcare System, New Haven
| | | | - Elena Losina
- Brigham and Women's Hospital, Boston, Massachusetts
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Harrold LR, Reed GW, John A, Barr CJ, Soe K, Magner R, Saunders KC, Ruderman EM, Haselkorn T, Greenberg JD, Gibofsky A, Harrington JT, Kremer JM. Cluster-Randomized Trial of a Behavioral Intervention to Incorporate a Treat-to-Target Approach to Care of US Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:379-387. [PMID: 28544704 PMCID: PMC5873265 DOI: 10.1002/acr.23294] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/16/2017] [Indexed: 11/08/2022]
Abstract
Objective To assess the feasibility and efficacy of implementing a treat‐to‐target approach versus usual care in a US‐based cohort of rheumatoid arthritis patients. Methods In this behavioral intervention trial, rheumatology practices were cluster‐randomized to provide treat‐to‐target care or usual care. Eligible patients with moderate/high disease activity (Clinical Disease Activity Index [CDAI] score >10) were followed for 12 months. Both treat‐to‐target and usual care patients were seen every 3 months. Treat‐to‐target providers were to have monthly visits with treatment acceleration at a minimum of every 3 months in patients with CDAI score >10; additional visits and treatment acceleration were at the discretion of usual care providers and patients. Coprimary end points were feasibility, assessed by rate of treatment acceleration conditional on CDAI score >10, and achievement of low disease activity (LDA; CDAI score ≤10) by an intent‐to‐treat analysis. Results A total of 14 practice sites per study arm were included (246 patients receiving treat‐to‐target and 286 receiving usual care). The groups had similar baseline demographic and clinical characteristics. Rates of treatment acceleration (treat‐to‐target 47% versus usual care 50%; odds ratio [OR] 0.92 [95% confidence interval (95% CI) 0.64, 1.34]) and achievement of LDA (treat‐to‐target 57% versus usual care 55%; OR 1.05 [95% CI 0.60, 1.84]) were similar between groups. Treat‐to‐target providers reported patient reluctance and medication lag time as common barriers to treatment acceleration. Conclusion This study is the first to examine the feasibility and efficacy of a treat‐to‐target approach in typical US rheumatology practice. Treat‐to‐target care was not associated with increased likelihood of treatment acceleration or achievement of LDA, and barriers to treatment acceleration were identified.
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Affiliation(s)
- Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and CORRONA, LLC, Waltham
| | - George W Reed
- University of Massachusetts Medical School, Worcester, and CORRONA, LLC, Waltham
| | - Ani John
- Genentech, South San Francisco, California
| | | | - Kevin Soe
- CORRONA, LLC, Waltham, Massachusetts
| | - Robert Magner
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Eric M Ruderman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | - Joel M Kremer
- Albany Medical College and The Center for Rheumatology, Albany, New York
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Larmore CJ, Boytsov NN, Gaich CL, Zhang X, Araujo AB, Rebello S, Salim BA, Reed GW, Harrold LR. Examination of Patient-Reported Outcomes in Association with TNF-Inhibitor Treatment Response: Results from a US Observational Cohort Study. Rheumatol Ther 2018; 5:215-229. [PMID: 29322372 DOI: 10.1007/s40744-017-0092-0] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Implementation of a treat-to-target strategy is challenging when the patient and physician prioritize different goals. This study aimed to "translate" improvements in Clinical Disease Activity Index (CDAI) to concepts that resonate with patients (such as pain, fatigue, morning stiffness) by examining the association between changes in disease activity and patient-reported outcomes (PROs) in a national cohort of patients with rheumatoid arthritis (RA) initiating their first biologic treatment. METHODS Patients in the Corrona registry with moderate or high disease activity (M/HDA) (defined by a CDAI score > 10), prior use of at least one conventional synthetic disease-modifying antirheumatic drug (csDMARD), 12-month follow-up, and initiating their first tumor necrosis factor inhibitor (TNFi) between 1 January 2006 through 1 November 2015 were identified. Patients were stratified on the basis of CDAI during follow-up, and changes in PROs were compared with a test of trend using CDAI-defined groups. RESULTS Of 1570 patients, 37% achieved sustained remission or low disease activity (remission/LDA), 15% had improving remission/LDA, 12% had worsening M/HDA, and 35% were in sustained M/HDA during 12-month follow-up. Those in sustained remission/LDA had greater magnitude of improvement in physical functioning, pain, fatigue, morning stiffness, patient's global assessment, and quality of life compared with patients in sustained M/HDA (p < 0.001). CONCLUSION Reduction in disease activity was associated with improvements in PROs, with the greatest improvements seen in those who achieved sustained remission/LDA. These results reinforce the benefits of a treat-to-target approach to RA care and may improve dialogue between patients and providers, support shared decision-making, and reduce "clinical inertia." FUNDING Corrona, LLC.
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Affiliation(s)
| | | | | | - Xiang Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
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Harrold LR, Litman HJ, Saunders KC, Dandreo KJ, Gershenson B, Greenberg JD, Low R, Stark J, Suruki R, Jaganathan S, Kremer JM, Yassine M. One-year risk of serious infection in patients treated with certolizumab pegol as compared with other TNF inhibitors in a real-world setting: data from a national U.S. rheumatoid arthritis registry. Arthritis Res Ther 2018; 20:2. [PMID: 29329557 PMCID: PMC5795286 DOI: 10.1186/s13075-017-1496-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/31/2017] [Accepted: 12/08/2017] [Indexed: 02/05/2023] Open
Abstract
Background Registry studies provide a valuable source of comparative safety data for tumor necrosis factor inhibitors (TNFi) used in rheumatoid arthritis (RA), but they are subject to channeling bias. Comparing safety outcomes without accounting for channeling bias can lead to inaccurate comparisons between TNFi prescribed at different stages of the disease. In the present study, we examined the incidence of serious infection and other adverse events during certolizumab pegol (CZP) use vs other TNFi in a U.S. RA cohort before and after using a methodological approach to minimize channeling bias. Methods Patients with RA enrolled in the Corrona registry, aged ≥ 18 years, initiating CZP or other TNFi (etanercept, adalimumab, golimumab, or infliximab) after May 1, 2009 (n = 6215 initiations), were followed for ≤ 12 months. A propensity score (PS) model was used to control for baseline characteristics associated with the probability of receiving CZP vs other TNFi. Incidence rate ratios (IRRs) of serious infectious events (SIEs), malignancies, and cardiovascular events (CVEs) in the CZP group vs other TNFi group were calculated with 95% CIs, before and after PS matching. Results Patients were more likely to initiate CZP later in the course of therapy than those initiating other TNFi. CZP initiators (n = 975) were older and had longer disease duration, more active disease, and greater disability than other TNFi initiators (n = 5240). After PS matching, there were no clinically important differences between CZP (n = 952) and other TNFi (n = 952). Before PS matching, CZP was associated with a greater incidence of SIEs (IRR 1.53 [95% CI 1.13, 2.05]). The risk of SIEs was not different between groups after PS matching (IRR 1.26 [95% CI 0.84, 1.90]). The 95% CI of the IRRs for malignancies or CVEs included unity, regardless of PS matching, suggesting no difference in risk between CZP and other TNFi. Conclusions After using PS matching to minimize channeling bias and compare patients with a similar likelihood of receiving CZP or other TNFi, the 1-year risk of SIEs, malignancies, and CVEs was not distinguishable between the two groups. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1496-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leslie R Harrold
- University of Massachusetts Medical School, Worcester, MA, USA. .,Pharmacoepidemiology and Outcomes Research, Corrona, 352 Turnpike Road, Suite 325, Southborough, MA, 01772, USA.
| | - Heather J Litman
- Pharmacoepidemiology and Outcomes Research, Corrona, 352 Turnpike Road, Suite 325, Southborough, MA, 01772, USA
| | - Katherine C Saunders
- Pharmacoepidemiology and Outcomes Research, Corrona, 352 Turnpike Road, Suite 325, Southborough, MA, 01772, USA
| | - Kimberly J Dandreo
- Pharmacoepidemiology and Outcomes Research, Corrona, 352 Turnpike Road, Suite 325, Southborough, MA, 01772, USA
| | - Bernice Gershenson
- University of Massachusetts Medical School, Worcester, MA, USA.,Pharmacoepidemiology and Outcomes Research, Corrona, 352 Turnpike Road, Suite 325, Southborough, MA, 01772, USA
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Tatlock S, Rüdell K, Panter C, Arbuckle R, Harrold LR, Taylor WJ, Symonds T. What Outcomes are Important for Gout Patients? In-Depth Qualitative Research into the Gout Patient Experience to Determine Optimal Endpoints for Evaluating Therapeutic Interventions. Patient 2017; 10:65-79. [PMID: 27384670 PMCID: PMC5250642 DOI: 10.1007/s40271-016-0184-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and Objectives Characterized by sudden onset of severe joint pain, swelling, redness, and tenderness to touch, gout ‘flare ups’ have a substantial impact on quality of life (QoL). This research employed a patient-centered approach to explore the symptoms and impacts of gout, and assess the content validity of existing patient-reported outcomes (PROs). Methods Qualitative interviews were conducted with 30 US gout patients (non-tophaceous: n = 20, tophaceous: n = 10) and five expert rheumatologists. Each interview included both concept elicitation (CE) questioning to learn about the patient experience and cognitive debriefing to assess the content validity of three PRO instruments (HAQ-DI, GAQ, and TIQ-20). Nine of the patients provided further real-time qualitative data through a smart phone application. All qualitative data were subject to thematic analysis using Atlas.ti. Two patient advisors and three expert clinicians were engaged as advisors at key stages throughout the research. Results Interview and real-time data identified the same core symptoms and proximal impact concepts. Severe pain (typically in joints of extremities) was described as the cardinal symptom, often accompanied by swelling, redness, heat, sensitivity to touch, and stiffness. Domains of QoL impacted included physical functioning, sleep, daily activities, and work. The PRO instruments were generally well-understood by patients, but each included items with questionable relevance to at least some of the sample, dependent on the specific joints affected. Conclusions Gout patients experience severe pain in affected joints, resulting in substantial limitations in physical functioning. Both the HAQ-DI and the TIQ-20 are useful for specific research purposes in the gout population, although modifications are recommended. Electronic supplementary material The online version of this article (doi:10.1007/s40271-016-0184-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophi Tatlock
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK.
| | - Katja Rüdell
- AstraZeneca, Da Vinci Building, Melbourn Science Park, Royston, Cambridgeshire, SG86EE, UK
| | - Charlotte Panter
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Rob Arbuckle
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - William J Taylor
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Tara Symonds
- Clinical Outcomes Solutions Ltd, Shearway Road, Folkestone, CT194RH, UK
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Harrold LR, John A, Reed GW, Haselkorn T, Karki C, Li Y, Best J, Zlotnick S, Kremer JM, Greenberg JD. Impact of Tocilizumab Monotherapy on Clinical and Patient-Reported Quality-of-Life Outcomes in Patients with Rheumatoid Arthritis. Rheumatol Ther 2017; 4:405-417. [PMID: 28936808 PMCID: PMC5696293 DOI: 10.1007/s40744-017-0081-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/02/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Tocilizumab (TCZ) monotherapy has been proven as an effective treatment for rheumatoid arthritis (RA) in clinical trials. However, there are limited data available regarding the effectiveness of TCZ monotherapy in real-world clinical settings in the United States. The objective of this study was to evaluate the impact of TCZ monotherapy on disease activity and patient-reported outcomes (PROs) in a US-based observational cohort of patients with RA seen in routine clinical practice. METHODS Eligible patients had active RA, no prior use of TCZ, and initiated TCZ as monotherapy. Changes in disease activity and PROs were assessed 1 year after TCZ initiation for the overall cohort and stratified by number of prior tumor necrosis factor inhibitors (TNFis; 0, 1, or ≥2). Primary outcomes were change in Clinical Disease Activity Index (CDAI); change in patient global disease activity, pain, fatigue; and the proportions of patients with improvement in modified Health Assessment Questionnaire (mHAQ), morning stiffness, and EQ-5D. RESULTS Of 255 eligible TCZ monotherapy initiators, 9.4% were TNFi naive, 36.5% had one prior TNFi, and 54.1% had ≥2 prior TNFis. Clinical and PRO measures indicated that patients were substantially impacted by their disease at baseline. The median decrease in CDAI from baseline to 1 year was 9.8 and median patient global and pain scores improved by 10 mm, indicative of clinically meaningful improvement; the median fatigue score improved by 5 mm. Approximately 26% of patients reported clinically meaningful improvement in mHAQ, 54% experienced improvement in morning stiffness, and 20% to 36% experienced improvement in EQ-5D domains (walking, self-care, usual activities, pain/discomfort, and anxiety/depression). Improvements were similar across TNFi groups. CONCLUSIONS Patients with active, refractory RA who initiated TCZ monotherapy experienced improvements in both composite disease activity scores and PROs at 1 year, regardless of prior TNFi exposure. FUNDING Corrona, LLC and Genentech.
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Affiliation(s)
- Leslie R Harrold
- University of Massachusetts Medical School, Worcester, MA, USA.
- Corrona, LLC, Southborough, MA, USA.
| | - Ani John
- Genentech, Inc., South San Francisco, CA, USA
| | - George W Reed
- University of Massachusetts Medical School, Worcester, MA, USA
- Corrona, LLC, Southborough, MA, USA
| | | | | | - YouFu Li
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennie Best
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Joel M Kremer
- Albany Medical College and the Center for Rheumatology, Albany, NY, USA
| | - Jeffrey D Greenberg
- Corrona, LLC, Southborough, MA, USA
- NYU School of Medicine, New York, NY, USA
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Harrold LR, Litman HJ, Connolly SE, Kelly S, Hua W, Alemao E, Rosenblatt L, Rebello S, Kremer JM. Effect of Anticitrullinated Protein Antibody Status on Response to Abatacept or Antitumor Necrosis Factor-α Therapy in Patients with Rheumatoid Arthritis: A US National Observational Study. J Rheumatol 2017; 45:32-39. [DOI: 10.3899/jrheum.170007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 11/22/2022]
Abstract
Objective.Assess whether baseline anticyclic citrullinated peptide antibodies (anti-CCP) status is associated with treatment response in patients with rheumatoid arthritis (RA) initiating abatacept (ABA) or a tumor necrosis factor-α inhibitor (TNFi).Methods.Using the Corrona RA registry, patients were identified who initiated ABA or a TNFi (June 2004–January 2015), had a followup visit 6 months (± 3 mos) after initiation, and anti-CCP measured at or prior to initiation. Primary outcome was mean change in Clinical Disease Activity Index (CDAI) from initiation to 6 months. Treatment response was evaluated based on a typical patient profile (female, aged 57 yrs, body mass index of 30 kg/m2, baseline CDAI of 20, 1 prior biologic, and no comorbidities other than RA). Secondary outcomes included remission and low disease activity.Results.There were 566 ABA initiators [anti-CCP+ (≥ 20 units/ml): n = 362; anti-CCP− (< 20 units/ml): n = 204] and 1715 TNFi initiators (anti-CCP+: n = 1113; anti-CCP−: n = 602). Differences between treatment groups included baseline disease duration, CDAI, and prior biologic use. At 6 months, anti-CCP+ ABA initiators were associated with significantly greater CDAI response versus anti-CCP− ABA initiators; no significant difference was observed for TNFi initiators. When considering a typical RA patient profile, CDAI response was greater in anti-CCP+ versus anti-CCP− ABA initiators; anti-CCP+ versus anti-CCP− TNFi initiators were similar. Secondary outcome responses were also greater in anti-CCP+ versus anti-CCP− ABA initiators; TNFi initiators did not differ by anti-CCP status.Conclusion.In a US-based clinical practice setting, anti-CCP status was associated with a differential treatment response to ABA, but not TNFi.
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Harrold LR, Stolshek BS, Rebello S, Collier DH, Mutebi A, Wade SW, Malley W, Greenberg JD, Etzel CJ. Rebound in Measures of Disease Activity and Symptoms in Corrona Registry Patients with Psoriatic Arthritis Who Discontinue Tumor Necrosis Factor Inhibitor Therapy after Achieving Low Disease Activity. J Rheumatol 2017; 45:78-82. [PMID: 28966209 DOI: 10.3899/jrheum.161567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/19/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Rebound may occur in patients with psoriatic arthritis (PsA) who discontinue TNF inhibitor (TNFi) therapy in low disease activity (LDA). METHODS Using physician and patient reports, we quantified rebound following TNFi discontinuation [defined as Clinical Disease Activity Index (CDAI) score > 10 or TNFi restart] and time to rebound in adults with PsA in LDA (CDAI score ≤ 10) at TNFi discontinuation. RESULTS Rebound occurred in 73% (69/94) of patients soon after discontinuation (median time to rebound 8.0 mos, 95% CI 6.0-12.0). CONCLUSION Rebound occurred frequently in patients with PsA after TNFi discontinuation. TNFi discontinuation after achieving LDA should be carefully considered.
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Affiliation(s)
- Leslie R Harrold
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA. .,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center.
| | - Bradley S Stolshek
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Sabrina Rebello
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - David H Collier
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Alex Mutebi
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Sally W Wade
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Wendi Malley
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Jeffrey D Greenberg
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
| | - Carol J Etzel
- From Corrona LLC, Southborough; Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Amgen Inc., Thousand Oaks, California; Wade Outcomes Research and Consulting, Salt Lake City, Utah; New York University School of Medicine, New York, New York; Department of Epidemiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.,L.R. Harrold, MD, MPH, Corrona LLC, and Department of Medicine, University of Massachusetts Medical School; B.S. Stolshek, PharmD, Amgen Inc.; S. Rebello, MPH, Corrona LLC; D.H. Collier, MD, Amgen Inc.; A. Mutebi, PhD, Amgen Inc.; S.W. Wade, MPH, Wade Outcomes Research and Consulting; W. Malley, MS, Corrona LLC, and New York University School of Medicine; J.D. Greenberg, MD, MPH, Corrona LLC; C.J. Etzel, PhD, Corrona LLC, and Department of Epidemiology, University of Texas, MD Anderson Cancer Center
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Curtis JR, Greenberg JD, Harrold LR, Kremer JM, Palmer JL. Influence of obesity, age, and comorbidities on the multi-biomarker disease activity test in rheumatoid arthritis. Semin Arthritis Rheum 2017; 47:472-477. [PMID: 28947312 DOI: 10.1016/j.semarthrit.2017.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 10/21/2016] [Revised: 07/19/2017] [Accepted: 07/26/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Traditional markers of inflammation are often required for inclusion in rheumatoid arthritis trials, yet patients with active disease may have normal lab tests. The potential use of the multi-biomarker disease activity (MBDA) test in this setting is unclear, as is understanding of whether it is influenced by patient characteristics (e.g., age, BMI, and comorbidities). METHODS Using data from the Corrona registry, we conducted a cross-sectional analysis of RA patients with MBDA tests. Patients were classified as low (<30), moderate (30-44, and high (>44) and by clinical and RA-related factors. Regression was used to evaluate the association between MBDA score and age, body mass index, comorbidities, and RA-related factors. RESULTS Of 357 eligible patients, 76% (n = 273) had normal CRP (<10mg/L) with high (33%), moderate (45%), and low (22%) disease activity by MBDA. The MBDA score was significantly associated with BMI, age, CDAI, and SJC. There was no association between MBDA score and fibromyalgia, diabetes, smoking, or COPD; none were confounders between MBDA score and either SJC or CDAI. For patients in CDAI remission, older age (2.6 units per decade; p = 0.03) and obesity (β = 10.5 for BMI > 30, referent to <25; p = 0.02) were independently associated with MBDA score. An adjusted MBDA score was proposed that was highly correlated with the original MBDA (r = 0.91). CONCLUSION In this real-world analysis, the MBDA score was associated with RA disease activity, obesity, and age, and was negligibly affected by common comorbidities. Almost one-third of patients with normal CRP had high MBDA scores. An adjustment to the MBDA score to account for body mass index and age is proposed.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, FOT 802, 510, 20th St South, Birmingham, AL 35294.
| | - Jeffrey D Greenberg
- Corrona LLC, Southborough, MA; Department of Medicine, New York University School of Medicine, New York, NY
| | - Leslie R Harrold
- Departments of Orthopedics and Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Joel M Kremer
- The Center for Rheumatology, Albany Medical College, Albany, NY
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de Lautour H, Taylor WJ, Adebajo A, Alten R, Burgos-Vargas R, Chapman P, Cimmino MA, da Rocha Castelar Pinheiro G, Day R, Harrold LR, Helliwell P, Janssen M, Kerr G, Kavanaugh A, Khanna D, Khanna PP, Lin C, Louthrenoo W, McCarthy G, Vazquez-Mellado J, Mikuls TR, Neogi T, Ogdie A, Perez-Ruiz F, Schlesinger N, Ralph Schumacher H, Scirè CA, Singh JA, Sivera F, Slot O, Stamp LK, Tausche AK, Terkeltaub R, Uhlig T, van de Laar M, White D, Yamanaka H, Zeng X, Dalbeth N. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. Arthritis Care Res (Hoboken) 2017; 68:667-72. [PMID: 26414176 DOI: 10.1002/acr.22741] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.
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Affiliation(s)
| | | | | | - Rieke Alten
- Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Ric Day
- University of New South Wales and St Vincent's Hospital, Sydney, Australia
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough
| | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | | | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC
| | | | | | - Puja P Khanna
- University of Michigan and Ann Arbor VA Medical Center, Ann Arbor
| | - Chingtsai Lin
- Taichung Veteran's General Hospital, Taichung, Taiwan
| | | | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | - Ted R Mikuls
- Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain
| | - Naomi Schlesinger
- Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Carlo A Scirè
- IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jasvinder A Singh
- University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham
| | | | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | | | | | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Douglas White
- Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Xuejun Zeng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Nicola Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
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Harrold LR, Reed GW, Karki C, Magner R, Shewade A, John A, Kremer JM, Greenberg JD. Risk of Infection Associated With Subsequent Biologic Agent Use After Rituximab: Results From a National Rheumatoid Arthritis Patient Registry. Arthritis Care Res (Hoboken) 2017; 68:1888-1893. [PMID: 27111064 PMCID: PMC5132134 DOI: 10.1002/acr.22912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/20/2016] [Accepted: 04/05/2016] [Indexed: 12/12/2022]
Abstract
Objective To assess whether the time between the last rituximab infusion and initiation of a different biologic agent influenced infection risk in patients with rheumatoid arthritis (RA). Methods Patients with RA who newly initiated rituximab within the Consortium of Rheumatology Researchers of North America registry were included if they switched to a nonrituximab biologic agent and had ≥1 followup visit within 12 months of switching. Patients were categorized by duration of time between their last rituximab infusion and initiation of a subsequent biologic agent (≤5 months, 6–11 months, and ≥12 months). The primary outcome was time to first infectious event. Adjusted Cox regression models estimated the association between time to starting a subsequent biologic agent and infection. Results A total of 44 overall infections (7 serious, 37 nonserious) were reported during the 12‐month followup in the 215 patients included in this analysis (104 switched at ≤5 months, 67 at 6–11 months, and 44 at ≥12 months). Median (interquartile range) time to infection was 4 (2–5) months. Infection rates per patient‐year in the ≤5‐month, 6–11‐month, and ≥12‐month groups were 0.34 (95% confidence interval [95% CI] 0.22–0.52), 0.30 (95% CI 0.17–0.52), and 0.41 (95% CI 0.22–0.77), respectively. After adjustment, time to switch to a subsequent biologic agent was not associated with infection, which remained unchanged when number and rate of rituximab retreatments were included in the models. Conclusion In this real‐world cohort of patients with RA, infection rates ranged from 0.30 to 0.41 per patient‐year, with no significant difference in the rate between patients who initiated a subsequent biologic agent earlier versus later after rituximab treatment.
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Affiliation(s)
- Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, Southborough, Massachusetts
| | - George W Reed
- University of Massachusetts Medical School, Worcester, and Corrona, Southborough, Massachusetts
| | | | - Robert Magner
- University of Massachusetts Medical School, Worcester
| | | | - Ani John
- Genentech, South San Francisco, California
| | - Joel M Kremer
- Albany Medical College and the Center for Rheumatology, Albany, New York
| | - Jeffrey D Greenberg
- Corrona, Southborough, Massachusetts, and New York University School of Medicine, New York
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Solomon DH, Losina E, Lu B, Zak A, Corrigan C, Lee SB, Agosti J, Bitton A, Harrold LR, Pincus T, Radner H, Yu Z, Smolen JS, Fraenkel L, Katz JN. Implementation of Treat-to-Target in Rheumatoid Arthritis Through a Learning Collaborative: Results of a Randomized Controlled Trial. Arthritis Rheumatol 2017; 69:1374-1380. [PMID: 28512998 DOI: 10.1002/art.40111] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/23/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Treat-to-target (TTT) is an accepted paradigm for the management of rheumatoid arthritis (RA), but some evidence suggests poor adherence. The purpose of this study was to test the effects of a group-based multisite improvement learning collaborative on adherence to TTT. METHODS We conducted a cluster-randomized quality-improvement trial with waitlist control across 11 rheumatology sites in the US. The intervention entailed a 9-month group-based learning collaborative that incorporated rapid-cycle improvement methods. A composite TTT implementation score was calculated as the percentage of 4 required items documented in the visit notes for each patient at 2 time points, as evaluated by trained staff. The mean change in the implementation score for TTT across all patients for the intervention sites was compared with that for the control sites after accounting for intracluster correlation using linear mixed models. RESULTS Five sites with a total of 23 participating rheumatology providers were randomized to intervention and 6 sites with 23 participating rheumatology providers were randomized to the waitlist control. The intervention included 320 patients, and the control included 321 patients. At baseline, the mean TTT implementation score was 11% in both arms; after the 9-month intervention, the mean TTT implementation score was 57% in the intervention group and 25% in the control group (change in score of 46% for intervention and 14% for control; P = 0.004). We did not observe excessive use of resources or excessive occurrence of adverse events in the intervention arm. CONCLUSION A learning collaborative resulted in substantial improvements in adherence to TTT for the management of RA. This study supports the use of an educational collaborative to improve quality.
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Affiliation(s)
| | - Elena Losina
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Bing Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Agnes Zak
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sara B Lee
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Asaf Bitton
- Brigham and Women's Hospital and Ariadne Labs, Boston, Massachusetts
| | | | | | | | - Zhi Yu
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Liana Fraenkel
- Yale School of Medicine and VA Connecticut Healthcare System, New Haven, Connecticut
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Harrold LR, Etzel CJ, Gibofsky A, Kremer JM, Pillinger MH, Saag KG, Schlesinger N, Terkeltaub R, Cox V, Greenberg JD. Sex differences in gout characteristics: tailoring care for women and men. BMC Musculoskelet Disord 2017; 18:108. [PMID: 28292303 PMCID: PMC5351188 DOI: 10.1186/s12891-017-1465-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/01/2017] [Indexed: 12/22/2022] Open
Abstract
Background To characterize the differences between women and men with gout. Methods We analyzed a US national cohort of gout patients cared for by rheumatologists. Results Compared with the 1012 men with gout, women with gout (n = 262) were older (71 vs. 61 years, p < 0.001) and had a greater burden of comorbid conditions (p < 0.001 for hypertension, diabetes, renal disease and obesity). Risk factors for gout differed with women more often taking diuretics (p < 0.001), while men more frequently had dietary triggers (p < 0.05). Conclusions The profiles of women and men with gout are markedly different, suggesting a need to tailor treatment recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1465-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leslie R Harrold
- Department of Medicine and Orthopedics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Carol J Etzel
- Corrona, LLC, Southborough, MA, USA.,Department of Epidemiology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Allan Gibofsky
- Hospital for Special Surgery-Weill Medical College of Cornell University, New York, NY, USA
| | - Joel M Kremer
- Albany Medical College and The Center for Rheumatology, Albany, NY, USA
| | | | - Kenneth G Saag
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Jeffrey D Greenberg
- Corrona, LLC, Southborough, MA, USA.,NYU School of Medicine, New York, NY, USA
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50
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Harrold LR, Stolshek BS, Rebello S, Collier DH, Mutebi A, Wade SW, Malley W, Greenberg JD, Etzel CJ. Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry. Clin Rheumatol 2017; 36:895-901. [DOI: 10.1007/s10067-017-3593-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 01/05/2023]
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