Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study
Background: Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD). Methods: Pooled analysis of nine national registries of p...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2016-09-01
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| Series: | EBioMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352396416303735 |
| _version_ | 1818302156156960768 |
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| author | D.S. Courvoisier D. Alpizar-Rodriguez J.E. Gottenberg M.V. Hernandez F. Iannone E. Lie M.J. Santos K. Pavelka C. Turesson X. Mariette D. Choquette M.L. Hetland A. Finckh |
| author_facet | D.S. Courvoisier D. Alpizar-Rodriguez J.E. Gottenberg M.V. Hernandez F. Iannone E. Lie M.J. Santos K. Pavelka C. Turesson X. Mariette D. Choquette M.L. Hetland A. Finckh |
| author_sort | D.S. Courvoisier |
| collection | DOAJ |
| description | Background: Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD).
Methods: Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes.
Findings: We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p = 0.03), and EULAR good or moderate responses at 1 year was much higher among ‘rapid responders’ (p < 0.001).
Interpretation: Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation. |
| first_indexed | 2024-12-13T05:34:25Z |
| format | Article |
| id | doaj.art-3138db8535934ae1bd83eb48f6868f30 |
| institution | Directory Open Access Journal |
| issn | 2352-3964 |
| language | English |
| last_indexed | 2024-12-13T05:34:25Z |
| publishDate | 2016-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EBioMedicine |
| spelling | doaj.art-3138db8535934ae1bd83eb48f6868f302022-12-21T23:57:58ZengElsevierEBioMedicine2352-39642016-09-0111C30230610.1016/j.ebiom.2016.08.024Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort StudyD.S. Courvoisier0D. Alpizar-Rodriguez1J.E. Gottenberg2M.V. Hernandez3F. Iannone4E. Lie5M.J. Santos6K. Pavelka7C. Turesson8X. Mariette9D. Choquette10M.L. Hetland11A. Finckh12University Hospitals Geneva, SwitzerlandUniversity Hospitals Geneva, SwitzerlandStrasbourg University Hospital, FranceHospital Clinic of Barcelona, SpainRheumatology Unit, University Hospital, Bari, ItalyDiakonhjemmet Hospital, Oslo, NorwayRheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, PortugalInstitute of Rheumatology, Prague, Czech RepublicDepartment of Clinical Sciences, Malmö, Lund University, Malmö, SwedenHôpitaux Universitaires Paris-Sud, Université Paris-Sud, FranceInstitut de Rhumatologie de Montréal, CHUM, CanadaThe DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen, DenmarkUniversity Hospitals Geneva, SwitzerlandBackground: Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD). Methods: Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes. Findings: We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (p = 0.03), and EULAR good or moderate responses at 1 year was much higher among ‘rapid responders’ (p < 0.001). Interpretation: Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.http://www.sciencedirect.com/science/article/pii/S2352396416303735AbataceptRheumatoid arthritisDisease activityDAS28Longitudinal dataDrug retentionResponse rate |
| spellingShingle | D.S. Courvoisier D. Alpizar-Rodriguez J.E. Gottenberg M.V. Hernandez F. Iannone E. Lie M.J. Santos K. Pavelka C. Turesson X. Mariette D. Choquette M.L. Hetland A. Finckh Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study EBioMedicine Abatacept Rheumatoid arthritis Disease activity DAS28 Longitudinal data Drug retention Response rate |
| title | Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study |
| title_full | Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study |
| title_fullStr | Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study |
| title_full_unstemmed | Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study |
| title_short | Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study |
| title_sort | rheumatoid arthritis patients after initiation of a new biologic agent trajectories of disease activity in a large multinational cohort study |
| topic | Abatacept Rheumatoid arthritis Disease activity DAS28 Longitudinal data Drug retention Response rate |
| url | http://www.sciencedirect.com/science/article/pii/S2352396416303735 |
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