Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: The disease activity score (DAS) was developed in RA to guide therapy. Its utility in practice for early rheumatoid arthritis (ERA) has
not been fully studied. The aim was to determine factors most strongly associated with an increase in therapy in ERA at 3 and 6
months.
Methods: Data were collected from Canadian Early Arthritis Cohort (CATCH) patients who were included if they had >2
visits and baseline and 6 months data. A regression analysis determined factors associated with treatment intensification.
Results: Of the 1,145 ERA patients, 790 met inclusion criteria. Mean age was 53.4 (SD 14.7), disease duration 6.1
months (SD 2.8), 75% were female, baseline DAS28 was 4.7 (SD 1.8) and 2.9 (SD 1.8) at 6 months. Factors most
strongly associated with intensifying treatment in univariate analyses were MD global (assessment) (OR= 7.8 at 3 months
and OR=7.4 at 6 months, P<0.0005) and SJC (OR= 4.7 and OR=7.3 at 3 and 6 months, P<0.0005). DAS did not affect
treatment intensification as strongly in univariate analyses (OR= 3.0 at 3 months and OR=4.6 at 6 months, P<0.0005). In
the logistic regression model only MD global was consistently associated with treatment intensification (OR= 1.5 and
OR=1.2 at 3 and 6 months respectively, P<0.0005). DAS28 was not a consistent predictor of treatment intensification
(OR= 1.0, P= 0.987 at 3 months and OR=1.2 P=0.023 at 6 months). If adjusting for multiple comparisons, only MD global
was significant at both 3 and 6 months. When treatment was intensified; only 2% of physicians listed DAS28 as a reason
for the treatment change, compared to 52%, 50% and 24% for SJC, TJC and MD global respectively. For the same SJC,
larger joint involvement was more likely to influence treatment than small joint involvement at 3 months (OR=1.4,
P=0.027). At 3 (but not 6) months for the same joint count, larger joint involvement was more associated with increasing
therapy (P=0.027).
Conclusion: Physician global assessment was independently associated with an increase in treatment at 3 and 6
months in ERA, whereas DAS28 was only significant at 6 months. SJC was also strongly related to treatment
intensification at 6 months. Physicians rarely stated that DAS28 was the reason for increasing treatment and the data
demonstrate that MD global assessment (which is not part of the DAS) is the main reason for treatment intensification in
ERA.
Table 1. Summary of variables in logistic regression model of increase therapy (strict definition) at 3 and 6 months. Model had a
percent correct classification of 76.2% and P-value <0.0005 at 3 months and 79.3% and P-value <0.0005 at 6 months.
|
|
Age |
TJC |
SJC |
ESR |
CRP |
Patient Global Assessment |
HAQ-DI |
Pain Today |
MD Global Assessment |
DAS28 |
|
Exp(B) (95% C.I.) 3 months |
0.989 (0.975, 1.002) |
1.019 (0.985, 1.055) |
1.050 (0.998, 1.105) |
1.008 (0.991, 1.024) |
1.005 (0.984, 1.026) |
1.007 (0.996, 1.017) |
0.541 (0.357, 0.820) |
1.116 (0.995, 1.251) |
1.460 (1.316, 1.620) |
0.999 (0.855, 1.167) |
|
P-Value |
0.089 |
0.273 |
0.061 |
0.372 |
0.638 |
0229 |
0.004 |
0.060 |
<0.0005 |
0.987 |
|
Exp(B) (95% C.I.) 6 months |
* |
0.997 (0.962, 1.033) |
1.098 (1.040, 1.160) |
0.985 (0.968, 1.002) |
** |
1.015 (1.004, 1.027) |
0.872 (0.569, 1.336) |
0.996 (0.885, 1.122) |
1.249 (1.106, 1.412) |
1.235 (1.029, 1.481) |
|
P-Value |
– |
0.868 |
0.001 |
0.083 |
– |
0.007 |
0.529 |
0.952 |
<0.0005 |
0.023 |
Disclosure:
L. Pyne,
None;
V. P. Bykerk,
Amgen,
2,
Pfizer Inc,
2,
Hoffmann-La Roche, Inc.,
2,
United Chemicals of Belgium (UCB) Canada Inc., ,
2,
Bristol-Myers Squibb,
2,
Abbott Laboratories,
2,
Janssen Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.),
2;
C. A. Hitchon,
Amgen,
2,
Pfizer Inc,
2,
Hoffmann-La Roche, Inc.,
2,
United Chemicals of Belgium (UCB) Canada Inc.,
2,
Bristol-Myers Squibb,
2,
Abbott Laboratories,
2,
Janssen Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.).,
2;
E. Keystone,
Amgen,
2,
Pfizer Inc,
2,
Hoffmann-La Roche, Inc.,
2,
United Chemicals of Belgium (UCB) Canada Inc.,
2,
Bristol-Myers Squibb,
2,
Abbott Laboratories,
2,
Janssen Inc.,
2;
J. C. Thorne,
Amgen,
2,
Pfizer Inc,
2,
Hoffmann-La Roche, Inc.,
2,
United Chemicals of Belgium (UCB) Canada Inc.,
2,
Bristol-Myers Squibb,
2,
Abbott Laboratories,
2,
Janssen Inc.,
2;
B. Haraoui,
Amgen,
2,
Pfizer Inc,
2,
Hoffmann-La Roche, Inc.,
2,
United Chemicals of Belgium (UCB) Canada Inc., ,
2,
Bristol-Myers Squibb,
2,
Abbott Laboratories,
2,
Janssen Inc.,
2;
A. Bonner,
None;
J. E. Pope,
Amgen,
2,
Pfizer Inc,
2,
Hoffmann-La Roche, Inc.,
2,
United Chemicals of Belgium (UCB) Canada Inc.,
2,
Bristol-Myers Squibb,
2,
Abbott Laboratories,
2,
Janssen Inc.,
2;
CATCH Investigators,
None.
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