Optimal responses in disease activity scores to treatment in rheumatoid arthritis: Is a DAS28 reduction of >1.2 sufficient?

被引:10
作者
Mian, Aneela N. [1 ,2 ]
Ibrahim, Fowzia [1 ,2 ]
Scott, David L. [1 ,2 ]
Galloway, James [1 ,2 ]
机构
[1] Kings Coll Hosp London, Dept Rheumatol, Denmark Hill, London SE5 9RS, England
[2] Kings Coll London, Kings Coll Sch Med, Dept Rheumatol, Weston Educ Ctr, Denmark Hill, London SE5 9RT, England
基金
美国国家卫生研究院;
关键词
Rheumatoid arthritis; DAS28; Response criteria; COLLEGE-OF-RHEUMATOLOGY; IMPORTANT DIFFERENCE; REMISSION CRITERIA; CLINICAL-PRACTICE; GUIDELINES; THERAPY; TRIAL; CONTINUATION; VALIDATION; EQ-5D;
D O I
10.1186/s13075-016-1028-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The overall benefit of intensive treatment strategies in rheumatoid arthritis (RA) remains uncertain. We explored how reductions in disability and improvements in quality of life scores are affected by alternative assessments of reductions in disease activity scores for 28 joints (DAS28) in two trials of intensive treatment strategies in active RA. Methods: One trial (CARDERA) studied 467 patients with early active RA receiving 24 months of methotrexate monotherapy or steroid and disease-modifying anti-rheumatic drug (DMARD) combinations. The other trial (TACIT) studied 205 patients with established active RA; they received 12 months of treatment with DMARD combinations or biologic agents. We compared changes in the health assessment questionnaire (HAQ) and Euroqol-5D (EQ5D) at trial endpoints in European League Against Rheumatism (EULAR) good and moderate EULAR responders in patients in whom complete endpoint data were available. Results: In the CARDERA trial 98 patients (26 %) were good EULAR responders and 160 (32 %) were EULAR moderate responders; comparable data in TACIT were 66 (35 %) and 86 (46 %) patients. The magnitude of change in the HAQ and EQ5D was greater in both trials in EULAR good responders than in EULAR moderate responders. HAQ scores had a difference in of -0.49 (95 % CI -0.66, -0.32) in the CARDERA and -0.31 (95 % CI -0.47, -0.13) in the TACIT trial. With the EQ5D comparable differences were 0.12 (95 % CI 0.04, 0.19) and 0.15 (95 % CI 0.05, 0.25). Both exceeded minimum clinically important differences in HAQ and EQ5D scores. Conclusions: We conclude that achieving a good EULAR response with DMARDs and biologic agents in active RA results in substantially improved mean HAQ and EQ5D scores. Patients who achieve such responses should continue on treatment. However, continuing such treatment strategies is more challenging when only a moderate EULAR response is achieved. In these patients evidence of additional clinically important benefits in measures such as the HAQ should also be sought.
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页数:6
相关论文
共 26 条
[1]   Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data [J].
Alemao, Evo ;
Joo, Seongjung ;
Kawabata, Hugh ;
Al, Maiwenn J. ;
Allison, Paul D. ;
Rutten-van Molken, Maureen P. M. H. ;
Frits, Michelle L. ;
Iannaccone, Christine K. ;
Shadick, Nancy A. ;
Weinblatt, Michael E. .
ARTHRITIS CARE & RESEARCH, 2016, 68 (03) :308-317
[2]   Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point [J].
Aletaha, Daniel ;
Alasti, Farideh ;
Smolen, Josef S. .
ANNALS OF THE RHEUMATIC DISEASES, 2016, 75 (08) :1479-1485
[3]  
[Anonymous], 2007, AD ET INFL TREATM RH
[4]  
Brooks R., 2003, MEASUREMENT VALUATIO
[5]   The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications [J].
Bonnie Bruce ;
James F Fries .
Health and Quality of Life Outcomes, 1 (1)
[6]   Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in early rheumatoid arthritis [J].
Choy, E. H. S. ;
Smith, C. M. ;
Farewell, V. ;
Walker, D. ;
Hassell, A. ;
Chau, L. ;
Scott, D. L. .
ANNALS OF THE RHEUMATIC DISEASES, 2008, 67 (05) :656-663
[7]   BSR and BHPR rheumatoid arthritis guidelines on eligibility criteria for the first biological therapy [J].
Deighton, Chris ;
Hyrich, Kimme ;
Ding, Tina ;
Ledingham, Jo ;
Lunt, Mark ;
Luqmani, Raashid ;
Kiely, Patrick ;
Bukhari, Marwan ;
Abernethy, Rikki ;
Ostor, Andrew ;
Bosworth, Ailsa ;
Gadsby, Kate ;
McKenna, Frank ;
Finney, Diana ;
Dixey, Josh .
RHEUMATOLOGY, 2010, 49 (06) :1197-1199
[8]  
Fransen J, 2005, CLIN EXP RHEUMATOL, V23, pS93
[9]   Response criteria for rheumatoid arthritis in clinical practice:: how useful are they? [J].
Gülfe, A ;
Geborek, P ;
Saxne, T .
ANNALS OF THE RHEUMATIC DISEASES, 2005, 64 (08) :1186-1189
[10]   Disease activity level, remission and response in established rheumatoid arthritis: Performance of various criteria sets in an observational cohort, treated with anti-TNF agents [J].
Gulfe, Anders ;
Aletaha, Daniel ;
Saxne, Tore ;
Geborek, Pierre .
BMC MUSCULOSKELETAL DISORDERS, 2009, 10