ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1141

Comparisons of Quality of Life, Resource Use and Physical Functioning in RA Patients Classified As High, Moderate or Low Risk for Rapid Radiographic Progression

E Alemao1, S Joo2, P Allison3, M Al4, M Rutten-van Molken4, S Banerjee1, C Iannaccone5, M Frits5, N Shadick5, M Weinblatt5 and Katherine Liao6, 1Bristol-Myers Squibb, Princeton, NJ, 2Bristol-Myers Squibb, Hopewell, NJ, 3University of Pennsylvania, Philadelphia, PA, 4Erasmus University, Rotterdam, Netherlands, 5Brigham and Women's Hospital, Boston, MA, 6Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Health Services Research

Session Type: Abstract Submissions (ACR)

Background/Purpose: We developed and validated a prognostic model to identify subjects with elevated risk of rapid radiographic progression (RRP). The objective of this study was to compare differences in quality of life (QoL), resource use and clinical outcomes at 12 months in patients classified with high, moderate and low baseline risk of RRP by the prognostic model.       Methods: In a longitudinal cohort of RA patients with clinical and radiographic data in an outpatient setting, we applied the prognostic model to calculate the baseline probability of RRP. Variables to determine the probability of RRP in the prognostic model included seropositivity, body weight, disease duration, DAS28 (CRP) and total Sharp score. Based on the calculated probability of RRP, patients were categorized into low risk (probability 0 to 0.25), moderate risk (0.25 to 0.75) and high risk (>0.75) of RRP. The categorization was based on visual inspection of probability plots. QoL outcome measured by EQ5D, healthcare resource use (nursing home visits, home healthcare visits, surgeries, durable medical equipment use, hospitalization and ER visits) and clinical outcome of physical functioning measured by mHAQ at 12 months were compared by baseline RRP risk groups of low, moderate and high using analysis of variance for continuous variables and Chi-square test for categorical variables. Results: In the RA cohort, 942 (72.6%) patients had adequate data to calculate RRP. Of these, 414 (43.9%) were classified as low, 477 (50.6%) as medium and 51 (5.4%) as high risk of RRP at baseline. Patients in the low-risk group when compared with those in the moderate- and high-risk groups tended to be younger, have a lower number of swollen or tender joints (mean [SD] 9.4 yrs [11.5], 19.8 [14.2], 33.1 [12.9], respectively), and less likely to be treated with a biologic DMARD. Patients in the low- versus high-risk groups had higher QoL, lower resource use and higher physical functioning at 12 months (Table).

Table: QoL, Resource Use and Physical Functioning at 12 Months in Patients at Low, Moderate and High Baseline Risk of RRP

Outcomes

Low Risk of RRP

Moderate Risk of RRP

High Risk of RRP

EQ5D, mean (SD)**

0.83 (0.14)

0.79 (0.15)

0.72 (0.19)

ER visits, % of pts* 23.4 25.1 38.2
Nursing home visits, % of pts* 2.4 2.7 14.6
Home healthcare visits, % of pts* 4.8 13.5 36.0
Surgeries, % of pts* 15.4 25.4 38.2
DME use, % of pts* 21.0 33.2 58.4
Hospital visits, % of pts* 13.3 20.4 37.1

mHAQ, mean (SD)**

0.39 (0.42)

0.65 (0.50)

0.72 (0.19)

*p<0.05 based on Chi-square test; **p<0.05 based on analysis of variance

Conclusion: Patients categorized as having high risk of future RRP at baseline (compared with moderate and low risk of RRP) had worse outcomes at 12 months for QoL, resource utilization and physical functioning. These findings suggest that therapies are needed to improve QoL and resource utilization in these high-risk patients.

Disclosure:

E. Alemao,

BMS,

3,

BMS,

1;

S. Joo,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3;

P. Allison,
None;

M. Al,
None;

M. Rutten-van Molken,
None;

S. Banerjee,

BMS,

1,

BMS,

3;

C. Iannaccone,
None;

M. Frits,
None;

N. Shadick,

AbbVie, Amgen, Genentech,

2,

BMS, UCB, Crescendo Biosciences,

9;

M. Weinblatt,

BMS, Crescendo Bioscience, UCB, Abbvie, Roche, Janssen,

5,

BMS, Crescendo Bioscience, UCB,

2;

K. Liao,
None.

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