Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data

Nicola J. Gullick; Aneela N. Mian; Fowzia Ibrahim; David Walker; Andrew Hassell; Patrick D.W. Kiely; David A. Walsh; Adam Young; David L. Scott; Heidi Lempp; Jackie Sturt; Sofia Georgopoulou; Louise Prothero; Naomi Martin; Richard Jenner; Isabel Neatrour; Rhiannon Baggott; Allan Wailoo; Jonathan Tosh; James Galloway; Gabrielle Kingsley; David Scott; Brian Tom; Yujie Zhong; Aneela Mian

Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data

Nicola J. Gullick, Aneela N. Mian^*, Fowzia Ibrahim, David Walker, Andrew Hassell, Patrick D.W. Kiely, David A. Walsh, Adam Young, David L. Scott, Heidi Lempp, Jackie Sturt, Sofia Georgopoulou, Louise Prothero, Naomi Martin, Richard Jenner, Isabel Neatrour, Rhiannon Baggott, Allan Wailoo, Jonathan Tosh, James GallowayGabrielle Kingsley, David Scott, Brian Tom, Yujie Zhong, Aneela Mian

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objective The optimal treatment for active rheumatoid arthritis (RA) is unresolved, particularly in early RA. We used data from an observational cohort to develop the simple predictor algorithm and evaluated its application in two completed clinical trials in early and established RA. We assessed whether using a simple algorithm can identify patients who have persisting active disease despite treatment with disease-modifying drugs (DMARDs). We also examined if patients who have lower likelihoods of persisting active RA are likely to benefit from intensive treatment. Methods We developed a simple predictive score for persisting disease activity using conventional clinical assessments in an observational cohort of patients with early RA (ERAN). It was tested in two trials in early (CARDERA) and established (TACIT) RA. Persistent disease activity was defined as disease activity score for 28 joints (DAS28) > 3.2 at both 6 and 12 months. Results Regression modelling identified three main predictors of persisting active disease in ERAN; tender joint counts, health assessment questionnaire (HAQ) scores and ESR. We dichotomised these predictors (≥6 tender joint counts, ≥1.0 HAQ ≥20 mm/h ESR) in a four-point prediction score. This simple prediction score predicted persisting active disease in the ERAN cohort and both CARDERA and TACIT trials. Patients with high scores were more likely to have persistently active disease at 6 and 12 months. The relationship was weaker in TACIT because no patients were without any predictive factors. Conclusion Combining tender joint counts, ESR and HAQ in a simple predictive score prospectively identifies patients with higher risks of persistent disease activity over the next 12 months. More patients with all three risk factors had persistent active disease than those with none or one risk factor.

Original language	English
Pages (from-to)	810-815
Number of pages	6
Journal	Clinical and Experimental Rheumatology
Volume	35
Issue number	5
Publication status	Published - 2017

Keywords

Early rheumatoid arthritis
Health utility
Outcome
Treatment response

Cite this

Gullick, N. J., Mian, A. N., Ibrahim, F., Walker, D., Hassell, A., Kiely, P. D. W., Walsh, D. A., Young, A., Scott, D. L., Lempp, H., Sturt, J., Georgopoulou, S., Prothero, L., Martin, N., Jenner, R., Neatrour, I., Baggott, R., Wailoo, A., Tosh, J., ... Mian, A. (2017). Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data. Clinical and Experimental Rheumatology, 35(5), 810-815.

@article{3aee8571fa0446069d6918fedc191a1b,

title = "Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data",

abstract = "Objective The optimal treatment for active rheumatoid arthritis (RA) is unresolved, particularly in early RA. We used data from an observational cohort to develop the simple predictor algorithm and evaluated its application in two completed clinical trials in early and established RA. We assessed whether using a simple algorithm can identify patients who have persisting active disease despite treatment with disease-modifying drugs (DMARDs). We also examined if patients who have lower likelihoods of persisting active RA are likely to benefit from intensive treatment. Methods We developed a simple predictive score for persisting disease activity using conventional clinical assessments in an observational cohort of patients with early RA (ERAN). It was tested in two trials in early (CARDERA) and established (TACIT) RA. Persistent disease activity was defined as disease activity score for 28 joints (DAS28) > 3.2 at both 6 and 12 months. Results Regression modelling identified three main predictors of persisting active disease in ERAN; tender joint counts, health assessment questionnaire (HAQ) scores and ESR. We dichotomised these predictors (≥6 tender joint counts, ≥1.0 HAQ ≥20 mm/h ESR) in a four-point prediction score. This simple prediction score predicted persisting active disease in the ERAN cohort and both CARDERA and TACIT trials. Patients with high scores were more likely to have persistently active disease at 6 and 12 months. The relationship was weaker in TACIT because no patients were without any predictive factors. Conclusion Combining tender joint counts, ESR and HAQ in a simple predictive score prospectively identifies patients with higher risks of persistent disease activity over the next 12 months. More patients with all three risk factors had persistent active disease than those with none or one risk factor.",

keywords = "Early rheumatoid arthritis, Health utility, Outcome, Treatment response",

author = "Gullick, {Nicola J.} and Mian, {Aneela N.} and Fowzia Ibrahim and David Walker and Andrew Hassell and Kiely, {Patrick D.W.} and Walsh, {David A.} and Adam Young and Scott, {David L.} and Heidi Lempp and Jackie Sturt and Sofia Georgopoulou and Louise Prothero and Naomi Martin and Richard Jenner and Isabel Neatrour and Rhiannon Baggott and Allan Wailoo and Jonathan Tosh and James Galloway and Gabrielle Kingsley and David Scott and Brian Tom and Yujie Zhong and Aneela Mian",

year = "2017",

language = "English",

volume = "35",

pages = "810--815",

journal = "Clinical and Experimental Rheumatology",

issn = "0392-856X",

publisher = "Clinical and Experimental Rheumatology S.A.S.",

number = "5",

}

Gullick, NJ , Mian, AN , Ibrahim, F, Walker, D, Hassell, A, Kiely, PDW, Walsh, DA, Young, A, Scott, DL , Lempp, H , Sturt, J , Georgopoulou, S , Prothero, L , Martin, N , Jenner, R , Neatrour, I , Baggott, R, Wailoo, A, Tosh, J, Galloway, J , Kingsley, G, Scott, D, Tom, B, Zhong, Y & Mian, A 2017, 'Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data', Clinical and Experimental Rheumatology, vol. 35, no. 5, pp. 810-815.

TY - JOUR

T1 - Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data

AU - Gullick, Nicola J.

AU - Mian, Aneela N.

AU - Ibrahim, Fowzia

AU - Walker, David

AU - Hassell, Andrew

AU - Kiely, Patrick D.W.

AU - Walsh, David A.

AU - Young, Adam

AU - Scott, David L.

AU - Lempp, Heidi

AU - Sturt, Jackie

AU - Georgopoulou, Sofia

AU - Prothero, Louise

AU - Martin, Naomi

AU - Jenner, Richard

AU - Neatrour, Isabel

AU - Baggott, Rhiannon

AU - Wailoo, Allan

AU - Tosh, Jonathan

AU - Galloway, James

AU - Kingsley, Gabrielle

AU - Scott, David

AU - Tom, Brian

AU - Zhong, Yujie

AU - Mian, Aneela

PY - 2017

Y1 - 2017

N2 - Objective The optimal treatment for active rheumatoid arthritis (RA) is unresolved, particularly in early RA. We used data from an observational cohort to develop the simple predictor algorithm and evaluated its application in two completed clinical trials in early and established RA. We assessed whether using a simple algorithm can identify patients who have persisting active disease despite treatment with disease-modifying drugs (DMARDs). We also examined if patients who have lower likelihoods of persisting active RA are likely to benefit from intensive treatment. Methods We developed a simple predictive score for persisting disease activity using conventional clinical assessments in an observational cohort of patients with early RA (ERAN). It was tested in two trials in early (CARDERA) and established (TACIT) RA. Persistent disease activity was defined as disease activity score for 28 joints (DAS28) > 3.2 at both 6 and 12 months. Results Regression modelling identified three main predictors of persisting active disease in ERAN; tender joint counts, health assessment questionnaire (HAQ) scores and ESR. We dichotomised these predictors (≥6 tender joint counts, ≥1.0 HAQ ≥20 mm/h ESR) in a four-point prediction score. This simple prediction score predicted persisting active disease in the ERAN cohort and both CARDERA and TACIT trials. Patients with high scores were more likely to have persistently active disease at 6 and 12 months. The relationship was weaker in TACIT because no patients were without any predictive factors. Conclusion Combining tender joint counts, ESR and HAQ in a simple predictive score prospectively identifies patients with higher risks of persistent disease activity over the next 12 months. More patients with all three risk factors had persistent active disease than those with none or one risk factor.

AB - Objective The optimal treatment for active rheumatoid arthritis (RA) is unresolved, particularly in early RA. We used data from an observational cohort to develop the simple predictor algorithm and evaluated its application in two completed clinical trials in early and established RA. We assessed whether using a simple algorithm can identify patients who have persisting active disease despite treatment with disease-modifying drugs (DMARDs). We also examined if patients who have lower likelihoods of persisting active RA are likely to benefit from intensive treatment. Methods We developed a simple predictive score for persisting disease activity using conventional clinical assessments in an observational cohort of patients with early RA (ERAN). It was tested in two trials in early (CARDERA) and established (TACIT) RA. Persistent disease activity was defined as disease activity score for 28 joints (DAS28) > 3.2 at both 6 and 12 months. Results Regression modelling identified three main predictors of persisting active disease in ERAN; tender joint counts, health assessment questionnaire (HAQ) scores and ESR. We dichotomised these predictors (≥6 tender joint counts, ≥1.0 HAQ ≥20 mm/h ESR) in a four-point prediction score. This simple prediction score predicted persisting active disease in the ERAN cohort and both CARDERA and TACIT trials. Patients with high scores were more likely to have persistently active disease at 6 and 12 months. The relationship was weaker in TACIT because no patients were without any predictive factors. Conclusion Combining tender joint counts, ESR and HAQ in a simple predictive score prospectively identifies patients with higher risks of persistent disease activity over the next 12 months. More patients with all three risk factors had persistent active disease than those with none or one risk factor.

KW - Early rheumatoid arthritis

KW - Health utility

KW - Outcome

KW - Treatment response

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M3 - Article

AN - SCOPUS:85029738032

SN - 0392-856X

VL - 35

SP - 810

EP - 815

JO - Clinical and Experimental Rheumatology

JF - Clinical and Experimental Rheumatology

IS - 5

ER -

Predicting responses in patients with rheumatoid arthritis to disease-modifying agents using baseline clinical data

Abstract

Keywords

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