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Multibiomarker disease activity score may predict radiographic progression in patients with RA
Radiographic progression was lower in patients with rheumatoid arthritis and a low multibiomarker disease activity score compared to measurements of C-reactive protein, erythrocyte sedimentation rate or disease activity score of 28 joints, according to recently published research.
Researchers studied 220 patients from the Swedish Farmacotherapy (SWEFOT) trial with available multibiomarker disease activity (MBDA) scores from 487 patients with early rheumatoid arthritis (RA), symptom duration of less than 1 year and disease activity score of 28 joints (DAS28) above 3.2. Following 3 months of methotrexate monotherapy, responders continued treatment and non-responders with DAS28 of 3.2 or higher were randomly assigned to receive either a non-biological triple-therapy regimen of methotrexate, sulfasalazine and hydroxychloroquine, or methotrexate in addition to infliximab (Remicade, Janssen). Seventy-six patients had an adequate response to methotrexate and 144 were randomized to triple therapy or infliximab.
Twelve protein biomarkers were used to determine the MBDA score, including vascular cell adhesion molecule 1, vascular endothelial growth factor, epidermal growth factor, interleukin 6, tumor necrosis factor (TNF) receptor 1, matrix metalloproteinases 1 and 3, cartilage glycoprotein 39, also known as YKL-40, leptin, resistin, serum amyloid A and C-reactive protein (CRP).
Significant differences were observed between patients who had rapid radiographic progression and high MBDA scores compared with CRP, erythrocyte sedimentation rate (ESR) and DAS28, with MBDA being more predictive of radiographic progression. At 3 months, and at 1 year, low or moderate MBDA scores were associated with lower Sharp/van der Heijde scores, while no significant differences in DAS28 were observed. Reduced Sharp/van der Heijde scores from baseline were more closely associated with MBDA scores compared to low CRP or DAS28.
Thirty-three patients with low MBDA scores at month 3 had low CRP and ESR levels except for one patient, while 17 had low DAS28, and only one demonstrated radiographic progression at 2 years.
None of the patients who had a low MBDA score at month 3 or 1 year compared to a moderate score at baseline displayed radiographic progression at year 1, but high MBDA scores at baseline that remained high at 3 months were associated with radiographic progression. – by Shirley Pulawski
Disclosure: Hambardzumyan reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.