Arianna Dagliati1, Darren Plant2, Nisha Nair3, Meghna Jani4, Beatrice Amico5, Niels Peek6, Ann W Morgan7, John Isaacs8, Anthony G Wilson9, Kimme L Hyrich10, Nophar Geifman1, Anne Barton2. 1. Centre for Health Informatics and Manchester Molecular Pathology Innovation Centre, University of Manchester, Manchester, UK. 2. Versus Arthritis Centre for Genetics and Genomics, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. 3. Versus Arthritis Centre for Genetics and Genomics, University of Manchester, Manchester, UK. 4. Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UK. 5. University of Verona, Verona, Italy. 6. Centre for Health Informatics, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK. 7. University of Leeds School of Medicine, NIHR Leeds Biomedical Research Centre, and Leeds Teaching Hospitals NHS Trust, Leeds, UK. 8. Translational and Clinical Research Institute, Newcastle University, and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 9. Centre for Arthritis Research, Conway Institute, University College Dublin, Dublin, Ireland. 10. NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, and Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UK.
Abstract
OBJECTIVE: To determine whether using a reweighted disease activity score that better reflects joint synovitis, i.e., the 2-component Disease Activity Score in 28 joints (DAS28) (based on swollen joint count and C-reactive protein level), produces more clinically relevant treatment outcome trajectories compared to the standard 4-component DAS28. METHODS: Latent class mixed modeling of response to biologic treatment was applied to 2,991 rheumatoid arthritis (RA) patients in whom treatment with a biologic disease-modifying antirheumatic drug was being initiated within the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate cohort, using both 4-component and 2-component DAS28 scores as outcome measures. Patient groups with similar trajectories were compared in terms of pretreatment baseline characteristics (including disability and comorbidities) and follow-up characteristics (including antidrug antibody events, adherence to treatments, and blood drug levels). We compared the trajectories obtained using the 4- and 2-component scores to determine which characteristics were better captured by each. RESULTS: Using the 4-component DAS28, we identified 3 trajectory groups, which is consistent with previous findings. We showed that the 4-component DAS28 captures information relating to depression. Using the 2-component DAS28, 7 trajectory groups were identified; among them, distinct groups of nonresponders had a higher incidence of respiratory comorbidities and a higher proportion of antidrug antibody events. We also identified a group of patients for whom the 2-component DAS28 scores remained relatively low; this group included a high percentage of patients who were nonadherent to treatment. This highlights the utility of both the 4- and 2-component DAS28 for monitoring different components of disease activity. CONCLUSION: Here we show that the 2-component modified DAS28 defines important biologic and clinical phenotypes associated with treatment outcome in RA and characterizes important underlying response mechanisms to biologic drugs.
OBJECTIVE: To determine whether using a reweighted disease activity score that better reflects joint synovitis, i.e., the 2-component Disease Activity Score in 28 joints (DAS28) (based on swollen joint count and C-reactive protein level), produces more clinically relevant treatment outcome trajectories compared to the standard 4-component DAS28. METHODS: Latent class mixed modeling of response to biologic treatment was applied to 2,991 rheumatoid arthritis (RA) patients in whom treatment with a biologic disease-modifying antirheumatic drug was being initiated within the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate cohort, using both 4-component and 2-component DAS28 scores as outcome measures. Patient groups with similar trajectories were compared in terms of pretreatment baseline characteristics (including disability and comorbidities) and follow-up characteristics (including antidrug antibody events, adherence to treatments, and blood drug levels). We compared the trajectories obtained using the 4- and 2-component scores to determine which characteristics were better captured by each. RESULTS: Using the 4-component DAS28, we identified 3 trajectory groups, which is consistent with previous findings. We showed that the 4-component DAS28 captures information relating to depression. Using the 2-component DAS28, 7 trajectory groups were identified; among them, distinct groups of nonresponders had a higher incidence of respiratory comorbidities and a higher proportion of antidrug antibody events. We also identified a group of patients for whom the 2-component DAS28 scores remained relatively low; this group included a high percentage of patients who were nonadherent to treatment. This highlights the utility of both the 4- and 2-component DAS28 for monitoring different components of disease activity. CONCLUSION: Here we show that the 2-component modified DAS28 defines important biologic and clinical phenotypes associated with treatment outcome in RA and characterizes important underlying response mechanisms to biologic drugs.
Authors: Mohammad E Naffaa; Fadi Hassan; Avivit Golan-Cohen; Eugene Merzon; Ilan Green; Amir Saab; Ziv Paz Journal: Rheumatol Int Date: 2021-09-16 Impact factor: 2.631
Authors: Cynthia R Rovnaghi; Joseph Rigdon; Jean-Michel Roué; Monica O Ruiz; Victor G Carrion; Kanwaljeet J S Anand Journal: Front Pediatr Date: 2021-10-11 Impact factor: 3.418
Authors: John A Reynolds; Jennifer Prattley; Nophar Geifman; Mark Lunt; Caroline Gordon; Ian N Bruce Journal: Arthritis Res Ther Date: 2021-07-29 Impact factor: 5.156