ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2955

Does Guideline-Based Care Improve Outcomes That Matter to Patients? Tighter Control, Less Suffering, and Greater Well-Being over the Past Decade in Canadian RA Patients

Susan J. Bartlett1,2, Orit Schieir3, Marie-France Valois4, Carol A Hitchon5, Janet E. Pope6, Gilles Boire7, Boulos Haraoui8, Edward C. Keystone9, Diane Tin10, Carter Thorne11 and Vivian P. Bykerk12, 1Department of Medicine, Division of ClinEpi, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, 2Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 3Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, 4McGill University, Montreal, QC, Canada, 5University of Manitoba, Winnipeg, MB, Canada, 6Department of Medicine, Division of Rheumatology, University of Western Ontario, St Joseph's Health Care, London, ON, Canada, 7Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke and Universite de Sherbrooke, Sherbrooke, QC, Canada, 8Institute de Rheumatologie, Montreal, QC, Canada, 9University of Toronto, Toronto, ON, Canada, 10The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 11University of Toronto, Newmarket, ON, Canada, 122-005, Mt Sinai Hospital, Toronto, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , , ,

Session Information

Date: Wednesday, November 8, 2017

Session Title: Patient Outcomes, Preferences, and Attitudes III

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: Best practice recommendations can increase quality of care and improve clinical outcomes, however the impact of recommendations on outcomes that matter most to patients have not been evaluated. We compare changes in patient reported outcomes (PROs) valued most by people with RA in the first year of follow up, as well as prior (2007-10) and subsequent (2011-16) to the 2010 release of Treat to Target and 2011 Canadian RA Treatment Recommendations.   

 

Methods: Data included ERA adults enrolled in CATCH (Canadian early ArThritis CoHort) between 2007-16 who met 1987 or 2010 RA criteria and had active disease at enrolment. Standardized visits included clinical assessments, questionnaires, and laboratory tests every 3 months. Treatment was at the discretion of the rheumatologist and cohort investigators met annually to discuss ways to improve outcomes. We examined changes in DAS28, pain, fatigue, patient global and HAQ at 6 and 12 months prior to and after guidelines release.

 

Results: The sample included 1942 adults who were mostly female (72%) with a mean (SD) age of 55 (15), 2 (2) comorbidities, and symptom duration of 6 (3) months. At enrollment, almost all (95%) were in DAS28 moderate or high disease activity [MDA (42%), HDA (53%)], and were initially treated with csDMARDS (92%) and MTX (75%). CDAI, DAS28 and PROs by DAS28 disease levels are shown in the Table. As mean DAS28 scores decreased over the first year, similar clinically meaningful improvements in patient global, pain, and fatigue were also evident (-3.0, -2.8, -2.3, -0.6; p’s<.001). When comparing change in PROs in 2007-2010 vs 2011-2016, there were more rapid improvements in patient global and pain at 6 and 12 months (p’s<.001; Figure) and similar improvements in HAQ and fatigue.  

Conclusion: Results from this large country-wide study suggest that better disease control in the first year of RA translated to similar improvements in pain, fatigue and disability–symptoms that patients identify as important–resulting in greater overall well-being. These data offer additional evidence supporting the importance of early identification and control of disease activity to improve long term outcomes and quality of life in people with RA.

 

Participant characteristics.

Mean (SD)

Total

LDA

MDA

HDA

N (%)

1942

(93, 5%)

(828, 42%)

(1021, 53%)

DAS28

5.2 (1.3)

2.9 (0.2)

4.2 (0.5)

6.2 (0.8)

CDAI

28.1 (13.8)

10.8 (5.3)

19.4 (8.0)

36.9 (11.8)

Patient Global (0-10)

6.0 (2.8)

3.2 (2.2)

4.9 (2.7)

7.2 (2.4)

Pain (0-10)

5.7 (2.8)

3.3 (2.3)

4.6 (2.6)

6.8 (2.4)

Fatigue (0-10)

5.4 (3.0)

3.8 (2.8)

4.6 (2.9)

6.1 (2.9)

HAQ–DI (0-3)

1.1 (0.7)

0.6 (0.5)

0.8 (0.6)

1.4 (0.7)

Disclosure: S. J. Bartlett, None; O. Schieir, None; M. F. Valois, None; C. A. Hitchon, None; J. E. Pope, AbbVie, Amgen, Bayer, BMS, Celtrion, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, UCB, 5,Amgen, Bayer, BMS, GSK, Merck, Novartis, Pfizer, Roche, UCB, 2; G. Boire, None; B. Haraoui, AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Pfizer, Roche, Sandoz, 6,AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, and UCB;, 2,Pfizer, and UCB, 8; E. C. Keystone, Abbott Laboratories, Amgen Inc., AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Janssen Inc, Lilly Pharmaceuticals, Novartis Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, UCB, 2,Abbott Laboratories, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, UCB, 5,Amgen, Abbott Laboratories, Astrazeneca LP, Bristol-Myers Squibb Canada,, 8; D. Tin, None; C. Thorne, AbbVie, Amgen, Celgene, Lilly, Novartis, Pfizer, Sanofi, and UCB, 2,Medexus/Medac, 8,AbbVie, Amgen, Celgene, Centocor, Genzyme, Hospira, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, and UCB, 5; V. P. Bykerk, Amgen, Bristol-Myers Squibb Company, Gilead, Sanofi-Genzyme/Regeneron, Pfizer Pharmaceuticals, UCB, 5.

To cite this abstract in AMA style:

Bartlett SJ, Schieir O, Valois MF, Hitchon CA, Pope JE, Boire G, Haraoui B, Keystone EC, Tin D, Thorne C, Bykerk VP. Does Guideline-Based Care Improve Outcomes That Matter to Patients? Tighter Control, Less Suffering, and Greater Well-Being over the Past Decade in Canadian RA Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/does-guideline-based-care-improve-outcomes-that-matter-to-patients-tighter-control-less-suffering-and-greater-well-being-over-the-past-decade-in-canadian-ra-patients/. Accessed February 26, 2020.

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