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.
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 tumornecrosis 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.
Authors: Jaclyn Anderson; Liron Caplan; Jinoos Yazdany; Mark L Robbins; Tuhina Neogi; Kaleb Michaud; Kenneth G Saag; James R O'Dell; Salahuddin Kazi Journal: Arthritis Care Res (Hoboken) Date: 2012-05 Impact factor: 4.794
Authors: Jeffrey R Curtis; Lang Chen; Aseem Bharat; Elizabeth Delzell; Jeffrey D Greenberg; Leslie Harrold; Joel Kremer; Soko Setoguchi; Daniel H Solomon; Fenglong Xie; Huifeng Yun Journal: Arthritis Care Res (Hoboken) Date: 2014-12 Impact factor: 4.794
Authors: Jeffrey R Curtis; Ying Shan; Leslie Harrold; Jie Zhang; Jeffrey D Greenberg; George W Reed Journal: Arthritis Care Res (Hoboken) Date: 2013-10 Impact factor: 4.794
Authors: Josef S Smolen; Joel M Kremer; Carol L Gaich; Amy M DeLozier; Douglas E Schlichting; Li Xie; Ivaylo Stoykov; Terence Rooney; Paul Bird; Juan Miguel Sánchez Bursón; Mark C Genovese; Bernard Combe Journal: Ann Rheum Dis Date: 2016-10-31 Impact factor: 19.103
Authors: Leslie R Harrold; George W Reed; Joel M Kremer; Jeffrey R Curtis; Daniel H Solomon; Marc C Hochberg; Arthur Kavanaugh; Katherine C Saunders; Ying Shan; Tanya M Spruill; Dimitrios A Pappas; Jeffrey D Greenberg Journal: Arthritis Res Ther Date: 2016-04-26 Impact factor: 5.156