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Comparison of clinical, patient-reported outcomes shows variability in RA treatment response
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Among methotrexate-naïve patients or those who had few previous doses of the treatment, investigators found variability in clinical responses between patient-reported and clinical outcomes to rheumatoid arthritis treatment with methotrexate or tofacitinib.
Researchers randomly assigned 956 patients with rheumatoid arthritis and were either methotrexate-naïve or had received three or fewer doses of the treatment to receive either tofacitinib or methotrexate. Outcomes included the percentage of patients who achieved ACR70 responses; ACR50 responses; low disease activity, by simplified disease activity index (SDAI) and clinical disease activity index (CDAI); remission, by SDAI and CDAI; and patient-reported health assessment questionnaire-disability index (HAQ-DI) scores of less than 0.5. Investigators also assessed pain and global assessment of disease activity, according to researchers.
Roy Fleischmann
Results showed although patients who achieved low disease activity or remission by one definition at 6 months also achieved low disease activity or remission with other definitions, researchers found greater discordance between measures with methotrexate vs. tofacitinib. Concordance between CDAI and SDAI responses was high, according to results. Compared with clinical measures, researchers noted less improvement in patient-reported outcomes among patients achieving low disease activity or ACR50 responses.
“This analysis demonstrated two important points for clinical practice. The deeper the response, as measured by CDAI and SDAI, the more likely the patient is to improve their physical function as measured by the HAQ-DI,” Roy Fleischmann, MD, MACR, clinical professor of medicine at the University of Texas Southwestern Medical Center, told Healio.com/Rheumatology. “Also, the physician should be evaluating both domains of response in assessing the effectiveness of a medication — both clinical, as measured by CDAI or SDAI, and functional, as measured by HAQ-DI. Both of which are easy to do in clinical practice, as there may be discordance in the responses.” – by Casey Tingle
Disclosures: Fleischmann reports that he receives study grant support from and is a consultant for Pfizer Inc. Please see the full study for a list of all other authors’ relevant financial disclosures.
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