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Poor prognostic factors do not predict DMARD use in RA
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The prevalence of poor prognostic factors among patients with rheumatoid arthritis — such as functional limitation, extra-articular disease, seropositivity and erosions — does not predict the use of biologic or targeted synthetic disease modifying antirheumatic drugs, according to findings published in the Journal of Rheumatology.
“The presence of many poor prognostic factors in patients with recent-onset RA has been associated with increased risk of disease progression in both clinical trials and observational studies,” Evo Alemao, MS, RPh, of Bristol-Myers Squibb, and colleagues wrote. “However, a single, universal list of [poor prognostic factors] does not exist in RA, and there are important distinctions between how these factors are described by the American College of Rheumatology (ACR) and the EULAR. Further, even within ACR and EULAR treatment recommendations, the definitions and types of [poor prognostic factors] and their relative importance have continued to evolve.”
To characterize a group of patients with RA based on the number of poor prognostic factors, and to analyze treatment acceleration, clinical outcomes and work status based on poor prognostic factors during the course of 1 year, the researchers studied data from the Corrona RA registry. According to Alemao and colleagues, the registry is an ongoing, independent, prospective, national observational cohort of patient recruited from 169 private and academic practices in 40 states. For their study, the researchers focused on 3,458 adult patients with RA who were biologic-naïve and completed a 12-month follow-up.
Each patient included in the study was identified and categorized based on whether they had one or fewer, two, or three or more poor prognostic factors. The researchers then analyzed changes in medication, patients’ Clinical Disease Activity Index (CDAI) and work status from baseline to 12 months, using linear and logistic regression models.
Among the included patients, 43.1% had zero or one poor prognostic factor, 35.1% had two and 21.8% had three or more. According to the researchers, patients with three or more factors at baseline were older and had longer RA duration, as well as higher CDAI, compared with those with no or one factor. In the group with zero or one poor prognostic factor, 20.9% of patients received one or more biologics, compared with 23.3% in the group with two factors and 26.5% for those with three or more factors.
According to the researchers, the use of biologic and targeted synthetic DMARDs were similar among patients both with and without poor prognostic factors (P = .57).
“This was the largest real-world study to date, to our knowledge, to evaluate [poor prognostic factors] in patients with RA,” Alemao and colleagues wrote. “These results highlight the burden of [poor prognostic factors] in patients with RA and the importance of evaluating these factors even in an established disease, which is common practice in other therapeutic areas such as cardiovascular disease. Our results suggest that, despite the worse outcomes in patients with a greater number of [poor prognostic factors], the presence of these factors did not significantly predict treatment accelerations in connection with the initiation of biologics or the addition/switching of therapies.” – by Jason Laday
Disclosure: Alemao reports stock options/bond holdings in Bristol-Myers Squibb. Please see the study for all other authors’ relevant financial disclosures.
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