Session Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis
Session Type: Abstract Submissions (ACR)
Background/Purpose: According to the latest ACR/EULAR guidelines, Boolean remission in RA is defined as achievement of patient global assessment (PtGA) ≤1, 28-swollen joint count (SJC) ≤1, 28-tender joint count (TJC) ≤1, and C-reactive protein (CRP) ≤1 mg/dL. Recently, PtGA has been criticized for not accurately assessing RA disease activity, as it may reflect aspects not directly related to RA disease activity such as fibromyalgia, low back pain, depression or other conditions. The aim of this analysis was to assess the proportion of patients failing to achieve remission based on PtGA in a real-world, routine clinical care setting in Canada.
Methods: Biologic Treatment Registry Across Canada (BioTRAC) is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. In this analysis, data from RA patients who were treated with infliximab between January 2002 and June 2011 were used. Correlation of PtGA with other clinical outcome measures was assessed with general linear models.
Results: Eight hundred and thirty-eight RA patients who had 4,582 assessments were included in the analysis. Mean (SD) age was 55.6 (13.5) years and mean (SD) duration since diagnosis was 10.5 (19.8) years. A total of 2,015 instances of non-remission were identified, of which 620 (30.8%) were near-remission cases. Near-remission is defined as attainment of three of the four Boolean criteria (CRP, SJC, TJC and PtGA). Among these, PtGA was the most common reason of non-remission (54.0%), followed by 28-tender joint count (TJC28; 27.7%), C-reactive protein (CRP; 10.0%), and 28-swollen joint count (SJC28; 8.2%). General linear models using PtGA as the dependent variable showed a statistically significant (P<0.001) positive association with HAQ-DI (mean (95%CI) estimate = 2.57 (2.47, 2.67), TJC28 (0.21 (0.20, 0.22), SJC28 (0.24 (0.23, 0.26)), physician global assessment (0.67 (0.64, 0.70), and pain (0.940 (0.93, 0.95).
Conclusion: The results of this analysis have shown that PtGA is the most common limiting factor in achieving Boolean ACR/EULAR remission, accounting for as many as 54% of the near-remission cases. However, a positive association was observed between PtGA and clinical outcomes, functional activity, and pain. Further analyses are required to identify the determinants of patient global assessment.
JNJ, Amgen, Pfizer, Abbvie, UCB, Eli Lilly, Celgene, Takeda, Astra Zeneca, BMS, Roche,
Janssen Pharmaceutica Product, L.P.,
W. G. Bensen,
M. M. Khraishi,
Hoffman-La Roche Canada, Amgen and Pfizer Canada, and Abbott Canada.,
D. E. Sholter,
A. J. Lehman,
S. M. Otawa,
J. S. Sampalis,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-proportion-of-patients-with-rheumatoid-arthritis-fail-to-achieve-remission-based-on-the-patient-global-an-analysis-from-the-prospective-observational-biologic-treatment-registry-across-canada/