Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study
Identifieur interne : 001A61 ( Main/Exploration ); précédent : 001A60; suivant : 001A62Rheumatoid Arthritis Patients after Initiation of a New Biologic Agent: Trajectories of Disease Activity in a Large Multinational Cohort Study
Auteurs : D. S. Courvoisier [Suisse] ; D. Alpizar-Rodriguez [Suisse] ; J. E. Gottenberg [France] ; M. V. Hernandez [Espagne] ; F. Iannone [Italie] ; E. Lie [Norvège] ; M. J. Santos [Portugal] ; K. Pavelka [République tchèque] ; C. Turesson [Suède] ; X. Mariette [France] ; D. Choquette [Canada] ; M. L. Hetland [Danemark] ; A. Finckh [Suisse]Source :
- EBioMedicine [ 2352-3964 ] ; 2016.
Abstract
Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD).
Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes.
We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (
Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.
Url:
DOI: 10.1016/j.ebiom.2016.08.024
PubMed: 27558858
PubMed Central: 5049989
Affiliations:
- Canada, Danemark, Espagne, France, Italie, Norvège, Portugal, République tchèque, Suisse, Suède
- Bohême centrale, Île-de-France, Østlandet
- Orsay, Oslo, Prague
- Université Paris-Sud
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Pavelka</name><affiliation wicri:level="3"><nlm:aff id="af0035">Institute of Rheumatology, Prague, Czech Republic</nlm:aff><country xml:lang="fr">République tchèque</country><wicri:regionArea>Institute of Rheumatology, Prague</wicri:regionArea><placeName><settlement type="city">Prague</settlement><region type="région" nuts="2">Bohême centrale</region></placeName></affiliation></author><author><name sortKey="Turesson, C" sort="Turesson, C" uniqKey="Turesson C" first="C." last="Turesson">C. Turesson</name><affiliation wicri:level="1"><nlm:aff id="af0040">Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Malmö, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af0045">Department of Rheumatology, Skåne University Hospital, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Rheumatology, Skåne University Hospital, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Mariette, X" sort="Mariette, X" uniqKey="Mariette X" first="X." last="Mariette">X. Mariette</name><affiliation wicri:level="4"><nlm:aff id="af0050">Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Hôpitaux Universitaires Paris-Sud, Université Paris-Sud</wicri:regionArea><wicri:noRegion>Université Paris-Sud</wicri:noRegion><placeName><settlement type="city">Orsay</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="university">Université Paris-Sud</orgName></affiliation></author><author><name sortKey="Choquette, D" sort="Choquette, D" uniqKey="Choquette D" first="D." last="Choquette">D. Choquette</name><affiliation wicri:level="1"><nlm:aff id="af0055">Institut de Rhumatologie de Montréal, CHUM, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Institut de Rhumatologie de Montréal, CHUM</wicri:regionArea><wicri:noRegion>CHUM</wicri:noRegion></affiliation></author><author><name sortKey="Hetland, M L" sort="Hetland, M L" uniqKey="Hetland M" first="M. L." last="Hetland">M. L. Hetland</name><affiliation wicri:level="1"><nlm:aff id="af0060">The DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>The DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen</wicri:regionArea><wicri:noRegion>University of Copenhagen</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af0065">Department of Clinical Medicine, University of Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Clinical Medicine, University of Copenhagen</wicri:regionArea><wicri:noRegion>University of Copenhagen</wicri:noRegion></affiliation></author><author><name sortKey="Finckh, A" sort="Finckh, A" uniqKey="Finckh A" first="A." last="Finckh">A. 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S." last="Courvoisier">D. S. Courvoisier</name><affiliation wicri:level="1"><nlm:aff id="af0005">University Hospitals Geneva, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University Hospitals Geneva</wicri:regionArea></affiliation></author><author><name sortKey="Alpizar Rodriguez, D" sort="Alpizar Rodriguez, D" uniqKey="Alpizar Rodriguez D" first="D." last="Alpizar-Rodriguez">D. Alpizar-Rodriguez</name><affiliation wicri:level="1"><nlm:aff id="af0005">University Hospitals Geneva, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University Hospitals Geneva</wicri:regionArea></affiliation></author><author><name sortKey="Gottenberg, J E" sort="Gottenberg, J E" uniqKey="Gottenberg J" first="J. E." last="Gottenberg">J. E. Gottenberg</name><affiliation wicri:level="1"><nlm:aff id="af0010">Strasbourg University Hospital, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Strasbourg University Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Hernandez, M V" sort="Hernandez, M V" uniqKey="Hernandez M" first="M. V." last="Hernandez">M. V. Hernandez</name><affiliation wicri:level="1"><nlm:aff id="af0015">Hospital Clinic of Barcelona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Clinic of Barcelona</wicri:regionArea></affiliation></author><author><name sortKey="Iannone, F" sort="Iannone, F" uniqKey="Iannone F" first="F." last="Iannone">F. Iannone</name><affiliation wicri:level="1"><nlm:aff id="af0020">Rheumatology Unit, University Hospital, Bari, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Rheumatology Unit, University Hospital, Bari</wicri:regionArea><wicri:noRegion>Bari</wicri:noRegion></affiliation></author><author><name sortKey="Lie, E" sort="Lie, E" uniqKey="Lie E" first="E." last="Lie">E. Lie</name><affiliation wicri:level="3"><nlm:aff id="af0025">Diakonhjemmet Hospital, Oslo, Norway</nlm:aff><country xml:lang="fr">Norvège</country><wicri:regionArea>Diakonhjemmet Hospital, Oslo</wicri:regionArea><placeName><settlement type="city">Oslo</settlement><region nuts="2">Østlandet</region></placeName></affiliation></author><author><name sortKey="Santos, M J" sort="Santos, M J" uniqKey="Santos M" first="M. J." last="Santos">M. J. Santos</name><affiliation wicri:level="1"><nlm:aff id="af0030">Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal</nlm:aff><country xml:lang="fr">Portugal</country><wicri:regionArea>Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon</wicri:regionArea><wicri:noRegion>Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Pavelka, K" sort="Pavelka, K" uniqKey="Pavelka K" first="K." last="Pavelka">K. Pavelka</name><affiliation wicri:level="3"><nlm:aff id="af0035">Institute of Rheumatology, Prague, Czech Republic</nlm:aff><country xml:lang="fr">République tchèque</country><wicri:regionArea>Institute of Rheumatology, Prague</wicri:regionArea><placeName><settlement type="city">Prague</settlement><region type="région" nuts="2">Bohême centrale</region></placeName></affiliation></author><author><name sortKey="Turesson, C" sort="Turesson, C" uniqKey="Turesson C" first="C." last="Turesson">C. Turesson</name><affiliation wicri:level="1"><nlm:aff id="af0040">Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Clinical Sciences, Malmö, Lund University, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af0045">Department of Rheumatology, Skåne University Hospital, Malmö, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Rheumatology, Skåne University Hospital, Malmö</wicri:regionArea><wicri:noRegion>Malmö</wicri:noRegion></affiliation></author><author><name sortKey="Mariette, X" sort="Mariette, X" uniqKey="Mariette X" first="X." last="Mariette">X. Mariette</name><affiliation wicri:level="4"><nlm:aff id="af0050">Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Hôpitaux Universitaires Paris-Sud, Université Paris-Sud</wicri:regionArea><wicri:noRegion>Université Paris-Sud</wicri:noRegion><placeName><settlement type="city">Orsay</settlement><region type="region" nuts="2">Île-de-France</region></placeName><orgName type="university">Université Paris-Sud</orgName></affiliation></author><author><name sortKey="Choquette, D" sort="Choquette, D" uniqKey="Choquette D" first="D." last="Choquette">D. Choquette</name><affiliation wicri:level="1"><nlm:aff id="af0055">Institut de Rhumatologie de Montréal, CHUM, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Institut de Rhumatologie de Montréal, CHUM</wicri:regionArea><wicri:noRegion>CHUM</wicri:noRegion></affiliation></author><author><name sortKey="Hetland, M L" sort="Hetland, M L" uniqKey="Hetland M" first="M. L." last="Hetland">M. L. Hetland</name><affiliation wicri:level="1"><nlm:aff id="af0060">The DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>The DANBIO registry Rigshospitalet, Glostrup, University of Copenhagen</wicri:regionArea><wicri:noRegion>University of Copenhagen</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="af0065">Department of Clinical Medicine, University of Copenhagen, Denmark</nlm:aff><country xml:lang="fr">Danemark</country><wicri:regionArea>Department of Clinical Medicine, University of Copenhagen</wicri:regionArea><wicri:noRegion>University of Copenhagen</wicri:noRegion></affiliation></author><author><name sortKey="Finckh, A" sort="Finckh, A" uniqKey="Finckh A" first="A." last="Finckh">A. Finckh</name><affiliation wicri:level="1"><nlm:aff id="af0005">University Hospitals Geneva, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University Hospitals Geneva</wicri:regionArea></affiliation></author></analytic><series><title level="j">EBioMedicine</title><idno type="eISSN">2352-3964</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is often heterogeneous. We aimed to identify types of disease activity trajectories following the initiation of a new biologic DMARD (bDMARD).</p></sec><sec><title>Methods</title><p>Pooled analysis of nine national registries of patients with diagnosis of RA, who initiated Abatacept and had at least two measures of disease activity (DAS28). We used growth mixture models to identify groups of patients with similar courses of treatment response, and examined these patients' characteristics and effectiveness outcomes.</p></sec><sec><title>Findings</title><p>We identified three types of treatment response trajectories: ‘gradual responders’ (GR; 3576 patients, 91·7%) had a baseline mean DAS28 of 4·1 and progressive improvement over time; ‘rapid responders’ (RR; 219 patients, 5·6%) had higher baseline DAS28 and rapid improvement in disease activity; ‘inadequate responders’ (IR; 103 patients, 2·6%) had high DAS28 at baseline (5·1) and progressive worsening in disease activity. They were similar in baseline characteristics. Drug discontinuation for ineffectiveness was shorter among inadequate responders (<italic>p</italic> <italic>=</italic> <italic>0.03</italic>), and EULAR good or moderate responses at 1 year was much higher among ‘rapid responders’ (<italic>p</italic> <italic><</italic> <italic>0.001</italic>).</p></sec><sec><title>Interpretation</title><p>Clinical information and baseline clinical characteristics do not allow a reliable prediction of which trajectory the patients will follow after bDMARD initiation.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Aga, A B" uniqKey="Aga A">A.B. Aga</name></author><author><name sortKey="Lie, E" uniqKey="Lie E">E. Lie</name></author><author><name sortKey="Uhlig, T" uniqKey="Uhlig T">T. Uhlig</name></author><author><name sortKey="Olsen, I C" uniqKey="Olsen I">I.C. Olsen</name></author><author><name sortKey="Wierod, A" uniqKey="Wierod A">A. 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Santos</name></noRegion></country><country name="République tchèque"><region name="Bohême centrale"><name sortKey="Pavelka, K" sort="Pavelka, K" uniqKey="Pavelka K" first="K." last="Pavelka">K. Pavelka</name></region></country><country name="Suède"><noRegion><name sortKey="Turesson, C" sort="Turesson, C" uniqKey="Turesson C" first="C." last="Turesson">C. Turesson</name></noRegion><name sortKey="Turesson, C" sort="Turesson, C" uniqKey="Turesson C" first="C." last="Turesson">C. Turesson</name></country><country name="Canada"><noRegion><name sortKey="Choquette, D" sort="Choquette, D" uniqKey="Choquette D" first="D." last="Choquette">D. Choquette</name></noRegion></country><country name="Danemark"><noRegion><name sortKey="Hetland, M L" sort="Hetland, M L" uniqKey="Hetland M" first="M. L." last="Hetland">M. L. Hetland</name></noRegion><name sortKey="Hetland, M L" sort="Hetland, M L" uniqKey="Hetland M" first="M. L." last="Hetland">M. L. 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