Patient Profiles in Randomized Controlled Trials Versus a Real-World Study in Psoriatic Arthritis: Scoping Review and Metaanalysis.

IF 3.6 2区 医学 Q2 RHEUMATOLOGY
Gelsomina Alle, Clementina Lopez-Medina, Stefan Siebert, Frédéric Lavie, Wim Noel, Josef S Smolen, Laure Gossec
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引用次数: 0

Abstract

Objective: Patients with psoriatic arthritis (PsA) in randomized controlled trials (RCTs) may not reflect patients with PsA in clinical practice. Our objective was to perform a metaanalysis comparing the characteristics of patients with PsA in RCTs of biologic disease-modifying antirheumatic drugs (bDMARDs) to patient profiles in a real-world study.

Methods: Data sources included (1) a scoping literature review of phase III RCTs of bDMARDs in PsA published between 2015 and 2020, and (2) an international observational study of patients with PsA starting a bDMARD enrolled between 2015 and 2018 (PsABio; ClinicalTrials.gov: NCT02627768). Data collected at baseline included swollen and tender joint counts (SJC/TJC), presence of enthesitis, skin involvement (body surface area [BSA]), C-reactive protein (CRP), physician global assessment (PGA), and patient-reported outcomes (PROs; Health Assessment Questionnaire [HAQ], pain). Univariate random effects metaanalysis was conducted to calculate pooled means and proportions.

Results: Overall, 5654 patients from 10 RCTs were compared to 930 PsABio patients. Demographic data were similar. SJC/TJC were higher in RCTs than in PsABio (pooled means: 11.8/21.5 vs 5.7/11.9), and enthesitis was more frequent in RCTs (64.7% vs 48.2%), as were patients with a BSA ≥ 3% (62.2% vs 54%). PGA was higher in RCTs (59.7 vs 54.1). In contrast, PROs were similar, whereas CRP was significantly higher in PsABio (1.4 vs 1.1 mg/dL).

Conclusion: Patients with PsA starting a bDMARD in RCTs had highly active disease and a high patient-reported disease burden. In contrast, PsABio real-world patients starting a bDMARD had lower SJC/TJC, skin involvement, and PGA, but presented with similar patient-reported disease burden. The extrapolation of RCT data in clinical practice should take these elements into account.

银屑病关节炎随机对照试验与真实世界研究中的患者概况:范围界定综述与荟萃分析。
目的:随机对照试验(RCT)中的银屑病关节炎(PsA)患者可能无法反映临床实践中的患者。我们的目的是对生物改良抗风湿药(bDMARDs)随机对照试验中的 PsA 患者特征进行荟萃分析,并将其与真实世界研究中的患者特征进行比较:数据来源(a) 对2015-2020年发表的治疗PsA的bDMARDs III期RCT进行范围界定文献综述;(b) 对2015-2018年入组、开始使用bDMARD的PsA患者进行国际观察研究(PsABio:NCT02627768)。基线收集的数据包括关节肿胀和压痛计数(SJC/TJC)、关节炎、皮肤受累(体表面积-BSA-)、C反应蛋白(CRP)、医生总体评估(PhGA)和患者报告结果(HAQ、疼痛)。采用单变量随机效应荟萃分析法计算汇总的平均值和比例:总体而言,来自 10 项 RCT 的 5654 名患者与 930 名 PsABio 患者进行了比较。人口统计学数据相似。RCT中的SJC/TJC高于PsABio(汇集平均值分别为11.8/21.5 vs 5.7/11.9);RCT中的粘连炎更常见(64.7% vs 48.2%);BSA≥3%的患者也更常见(62.2% vs 54.0%)。RCT患者的PhGA更高(59.7毫米对54.1毫米)。相比之下,患者报告的结果相似,而PsABio的CRP明显更高(1.1 vs 1.4mg/dl):结论:在RCT中开始使用bDMARD的PsA患者病情高度活跃,患者报告的疾病负担较重。相比之下,现实世界中开始使用 bDMARD 的 PsABio 患者的关节数量、皮肤病和 PhGA 较低,但患者报告的疾病负担相似。在临床实践中推断 RCT 数据时应考虑到这些因素。
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来源期刊
Journal of Rheumatology
Journal of Rheumatology 医学-风湿病学
CiteScore
6.50
自引率
5.10%
发文量
285
审稿时长
1 months
期刊介绍: The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of our 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.
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