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Do Poor Prognostic Factors in Rheumatoid Arthritis Affect Treatment Choices and Outcomes? Analysis of a US Rheumatoid Arthritis Registry.

Authors
  • Alemao, Evo1, 2
  • Litman, Heather J3, 4
  • Connolly, Sean E3, 4
  • Kelly, Sheila3, 4
  • Hua, Winnie3, 4
  • Rosenblatt, Lisa3, 4
  • Rebello, Sabrina3, 4
  • Kremer, Joel M3, 4
  • Harrold, Leslie R3, 4
  • 1 From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA. [email protected] , (Jersey)
  • 2 E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School. [email protected]
  • 3 From Bristol-Myers Squibb, Princeton, New Jersey; Corrona LLC, Southborough, Massachusetts; Albany Medical College and The Center for Rheumatology, Albany, New York; University of Massachusetts Medical School, Worcester, Massachusetts, USA. , (Jersey)
  • 4 E. Alemao, MS, RPh, Bristol-Myers Squibb; H.J. Litman, PhD, Corrona LLC; S.E. Connolly, PhD, Bristol-Myers Squibb; S. Kelly, MD, Bristol-Myers Squibb; W. Hua, MS, Corrona LLC; L. Rosenblatt, MD, MPH, Bristol-Myers Squibb; S. Rebello, MPH, Corrona LLC; J.M. Kremer, MD, Corrona LLC, and Albany Medical College and The Center for Rheumatology; L.R. Harrold, MD, MPH, Corrona LLC, and the University of Massachusetts Medical School.
Type
Published Article
Journal
The Journal of rheumatology
Publication Date
Oct 01, 2018
Volume
45
Issue
10
Pages
1353–1360
Identifiers
DOI: 10.3899/jrheum.171050
PMID: 29961696
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To characterize patients with rheumatoid arthritis (RA) by number of poor prognostic factors (PPF: functional limitation, extraarticular disease, seropositivity, erosions) and evaluate treatment acceleration, clinical outcomes, and work status over 12 months by number of PPF. Using the Corrona RA registry (January 2005-December 2015), biologic-naive patients with diagnosed RA having 12-month (± 3 mos) followup were identified and categorized by PPF (0-1, 2, ≥ 3). Changes in medication, Clinical Disease Activity Index (CDAI), and work status (baseline-12 mos) were evaluated using linear and logistic regression models. There were 3458 patients who met the selection criteria: 1489 (43.1%), 1214 (35.1%), and 755 (21.8%) had 0-1, 2, or ≥ 3 PPF, respectively. At baseline, patients with ≥ 3 PPF were older, and had longer RA duration and higher CDAI versus those with 0-1 PPF. In 0-1, 2, and ≥ 3 PPF groups, respectively, 20.9%, 23.2%, and 26.5% of patients received ≥ 1 biologic (p = 0.011). Biologic/targeted synthetic disease-modifying antirheumatic drug (tsDMARD) use was similar in patients with/without PPF (p = 0.57). After adjusting for baseline CDAI, mean (standard error) change in CDAI was -4.95 (0.24), -4.53 (0.27), and -2.52 (0.34) for 0-1, 2, and ≥ 3 PPF groups, respectively. More patients were working at baseline but not at 12-month followup in 2 (13.9%) and ≥ 3 (12.5%) versus 0-1 (7.3%) PPF group. Despite high disease activity and worse clinical outcomes, number of PPF did not significantly predict biologic/tsDMARD use. This may warrant reconsideration of the importance of PPF in treat-to-target approaches.

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