Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Despite
an increasing armamentarium of efficacious treatments for Rheumatoid Arthritis
(RA), sustained remission remains an unrealistic expectation for many patients,
with most experiencing ongoing disease activity and flares of varying
frequency. The aim of the current study is to describe the patients who are
inadequately controlled (DAS28>3.2) on their current therapy and identify
common features associated with this population.
Methods: Data
were drawn from the Adelphi 2014 RA Disease Specific Programme, a survey of
rheumatologists and their RA patients in France, Germany, Italy, Spain and UK. Rheumatologists
provided patient demographics, comorbidities, satisfaction with RA control and
clinical details including current DAS28. Patients reported their satisfaction,
and completed the EuroQOL 5-Dimension Health Questionnaire (EQ-5D) and Work Productivity
and Activity Impairment (WPAI) Questionnaire. Of the patients who had been on
their current therapy for at least 3 months, two patient cohorts were created based
on the physician-reported DAS28: adequately and inadequately controlled (DAS28 ≤3.2
and >3.2 respectively). Univariate tests were performed to compare the
cohorts.
Results: A
total of 1147 patients had been on current therapy for at least 3 months and
had DAS28 scores reported, 74% were female, with a mean age of 52 years, and
mean time since RA diagnosis of 84 months. The table demonstrates that
compared with the adequately controlled cohort, inadequately controlled
patients were more affected clinically, had higher rates of depression, worse
quality of life and greater work and activity impairment. There were also lower
satisfaction rates among the patients and their physicians.
|
|
Adequately controlled |
Inadequately controlled* |
|
n: |
839 (73%) |
308 (27%) |
|
Rheumatologist reported clinical profile |
|
|
|
Perceived severity: ‘mild’ (%) |
87.4 |
31.2 |
|
Perceived severity: ‘moderate’ (%) |
11.9 |
58.1 |
|
Perceived severity: ‘severe’ (%) |
0.7 |
10.7 |
|
RA currently ‘improving’ (%) |
31.1 |
22.1 |
|
RA currently ‘stable’ (%) |
65.3 |
38.3 |
|
RA currently ‘unstable / deteriorating’ (%) |
3.6 |
39.6 |
|
Physician reports patient is currently ‘in remission’ (%) |
68.2 |
13.6 |
|
Current level of pain (mean, 1 none – 10 worst) |
2.3 |
4.6 |
|
Patient ever experiences flares: yes (%) |
41.4 |
67.3 |
|
Comorbidities (%): |
|
|
|
Depression |
5.4 |
15.6 |
|
No comorbidities |
56.9 |
34.7 |
|
BMI (mean) |
24.9 |
25.8 |
|
Treatment |
|
|
|
Months receiving current therapy (mean) |
25.9 |
24.8^ |
|
Ever received a bDMARD (%) |
44.0 |
51.0 |
|
Status of bDMARD (% of patients prescribed a bDMARD): |
|
|
|
Currently receiving 1st bDMARD therapy |
68.0 |
52.9 |
|
Impact on the patient |
|
|
|
Quality of life: EQ-5D score (mean) |
0.77 |
0.53 |
|
Employment: Full time employed (%) |
46.0 |
29.2 |
|
WPAI: % Overall work impairment (mean) |
18.4 |
33.5@ |
|
WPAI: % Presenteeism (mean) |
16.5 |
32.2 |
|
WPAI: % Activity impairment (mean) |
26.7 |
48.2 |
|
Satisfaction with RA control (%) |
|
|
|
Physician ‘satisfied’ |
88.4 |
31.2 |
|
Patient ‘satisfied’ |
84.6 |
55.1 |
*:
Variables significantly different from ‘adequately controlled’ cohort,
p<0.01 unless indicated by @: p=0.0146, or ^: not significant
Conclusion: Results
show that almost a third of RA patients are insufficiently controlled despite
current therapy. Even though these patients are more affected clinically, more
impacted in their daily lives and less satisfied overall, the data indicated
that in some cases physicians may perceive these patients to be ‘mild’, or ‘in
remission’. The discordance between physicians’ perceptions and the objective
DAS28 in some patients may result in less than optimal therapeutic management,
the result of which may be sustained periods of unnecessary active disease.
Furthermore, over half of patients who are not adequately controlled report being
satisfied with the control their RA therapy provides, suggesting they too may
be accepting sub-optimal outcomes and not look to change treatment.
To cite this abstract in AMA style:
Taylor PC, Alten R, Bertin P, Caporali R, Gomez-Reino JJ, Sullivan E, Wood R, Piercy J, Vasilescu R, Spurden D, Alvir J. Clinical Characteristics and Health Outcomes of RA Patients Not Adequately Controlled By Current Treatment [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-characteristics-and-health-outcomes-of-ra-patients-not-adequately-controlled-by-current-treatment/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-and-health-outcomes-of-ra-patients-not-adequately-controlled-by-current-treatment/