ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 889

The Utility of Patient-Reported Outcomes in Predicting Disease Activity in Patients with Takayasu’s Arteritis

Antoine G. Sreih1, Tanaz A. Kermani2, Gunnar Tomasson3, Joshua F. Baker4, David Cuthbertson5, Renee Borchin6, Simon Carette7, Lindsy J. Forbess8, Gary S. Hoffman9, Nader A. Khalidi10, Curry L. Koening11, Carol A. McAlear12, Paul A. Monach13, Larry W. Moreland14, Christian Pagnoux15, Philip Seo16, Robert F. Spiera17, Kenneth J. Warrington18, Steven R. Ytterberg2, Carol A. Langford19 and Peter A. Merkel20, 1Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, 2Rheumatology, Mayo Clinic, Rochester, MN, 3Dept of Public Health Sciences, University of Iceland, Reykjavik, IS, 4Rheumatology, University of Pennsylvania, Philadelphia, PA, 5Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, 6University of South Florida, Tampa, FL, 7Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 8Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 9Rheumatology, Cleveland Clinic, Cleveland, OH, 10Division of Rheumatology, McMaster University, Hamilton, ON, Canada, 11Rheumatology, University of Utah, Salt Lake City, UT, 12University of Pennsylvania, Philadelphia, PA, 13Rheumatology, Boston University School of Medicine, Boston, MA, 14Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, 15Division of Rheumatology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Canada, Toronto, ON, Canada, 16Medicine, Johns Hopkins University, Baltimore, MD, 17Hospital for Special Surgery, Cornell, New York, NY, 18Rheumatology, University of California Los Angeles, CA, USA Mayo, Rochester, MN, 19Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, 20Division of Rheumatology, Univ of Pennsylvania; Perelman School of Med, Philadelphia, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , , ,

Session Information

Date: Sunday, November 13, 2016

Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Takayasu’s arteritis (TAK) is a relapsing large vessel vasculitis. There are currently no reliable predictors of disease relapse. This study explored whether changes in patient-reported outcomes (PROs) during periods of remission are associated with future disease relapse in TAK.  

Methods: Data from patients with TAK participating in a longitudinal cohort and/or a clinical trial in TAK were available for this analysis; quarterly assessments were made. Patients completed a patient global assessment (PtGA) on a 100-mm visual analog scale with higher scores indicating worse disease activity, and the 36-item Short Form Health Survey (SF-36) from which the physical component scores (PCS) and mental component scores (MCS) were calculated and normalized to the general population (mean ± SD=50 ± 10) with lower scores indicating worse outcomes. ESR and CRP were measured at each visit. Physicians determined disease state (remission or active) at each visit and whether a relapse had occurred since last visit. The 2 visits preceding relapse (remission visits) and the study visit following or concurrent with relapse (relapse visit) were used for analysis. Robust generalized estimating equations in logistic regression models evaluated associations between changes in PtGA, PCS, MCS, ESR, and CRP in the 2 remission visits preceding relapse and disease relapse, adjusting for intra-subject correlations, age, and sex.  

Results: 207 patients with TAK were seen at a total of 1,077 study visits (881 remission and 196 relapse visits); 97% were female with a mean age at entry (± SD) of 38.7 ± 12.9 years. Table 1 shows the mean PtGA, PCS, MCS, ESR and CRP during remission and relapse visits. An increase of 10 mm in PtGA or a decrease in PCS scores by 1 point between the 2 visits preceding relapse were associated with disease relapse (OR [95% CI]= 1.23 [1.05-1.45], p=0.011 for PtGA and 1.07 [1.02-1.13], p=0.016 for PCS). Changes in MCS, ESR, or CRP were not associated with disease relapse (OR=1.10 [0.96-1.05, p=0.638, OR=1.01 [0.97-1.04], p=0.546, OR=1.00 [0.95-1.03], p=0.864 for MCS, ESR and CRP respectively).  

Conclusion: Changes in patient global assessment and the SF-36 physical component scores, but not the SF-36 mental component scores, during periods of remission are associated with future disease relapse. Changes in ESR or CRP during periods of remission do not predict future disease relapse. These findings suggest that patients are good predictors of disease relapse and the current measures of disease activity and definitions of relapse in TAK are problematic and should incorporate patient-reported outcomes.

Disclosure: A. G. Sreih, Alexion Pharmaceuticals, Inc., 1,Bristol-Myers Squibb, 2,Celgene, 2,Chemocentryx, 2,Roche Pharmaceuticals, 2,GlaxoSmithKline, 2,Kropp and Partners, 5; T. A. Kermani, GlaxoSmithKline, 2; G. Tomasson, None; J. F. Baker, None; D. Cuthbertson, None; R. Borchin, None; S. Carette, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2; L. J. Forbess, None; G. S. Hoffman, None; N. A. Khalidi, Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2; C. L. Koening, None; C. A. McAlear, None; P. A. Monach, Genentech and Biogen IDEC Inc., 2,Bristol-Myers Squibb, 2,MedScape, 5,GlaxoSmithKline, 2,Vasculitis Foundation Board of Directors, 6,Editorial Board of Arthritis and Rheumatology, 6; L. W. Moreland, Genentech and Biogen IDEC Inc., 2,Pfizer Inc, 2,questcor, 2,Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2,Pfizer Inc, 5,Boehringer Ingelheim, 5,Acerta, 5,CVS/Caremark, 5,Smith Kline Beecham, 5; C. Pagnoux, Chemocentryx, 5,Chemocentryx, 9,Roche Pharmaceuticals, 9,Roche Pharmaceuticals, 5,Sanofi-Aventis Pharmaceutical, 5,Hoffmann-La Roche, Inc., 8; P. Seo, Bristol-Myers Squibb, 2; R. F. Spiera, GlaxoSmithKline, 2,Roche Pharmaceuticals, 2,Boehringer Ingelheim, 2,PRISM, 2,Cytori, 2,Corbus Pharmaceuticals, 2,GlaxoSmithKline, 5,Roche Pharmaceuticals, 5,Boehringer Ingelheim, 5,Bristol-Myers Squibb, 2; K. J. Warrington, GlaxoSmithKline, 2; S. R. Ytterberg, Sanofi-Aventis Pharmaceutical, 5; C. A. Langford, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2,Bristol-Myers Squibb, 2; P. A. Merkel, Chemocentryx, 5,Chemocentryx, 9.

To cite this abstract in AMA style:

Sreih AG, Kermani TA, Tomasson G, Baker JF, Cuthbertson D, Borchin R, Carette S, Forbess LJ, Hoffman GS, Khalidi NA, Koening CL, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Spiera RF, Warrington KJ, Ytterberg SR, Langford CA, Merkel PA. The Utility of Patient-Reported Outcomes in Predicting Disease Activity in Patients with Takayasu’s Arteritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-utility-of-patient-reported-outcomes-in-predicting-disease-activity-in-patients-with-takayasus-arteritis/. Accessed .

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