Remission and low disease activity matrix tools: results in real-world rheumatoid arthritis patients under anti-TNF therapy.

IF 1 4区医学 Q4 RHEUMATOLOGY

Acta reumatologica portuguesa Pub Date : 2020-10-01

Sara Ganhão, Raquel Lucas, João Eurico Fonseca, Maria José Santos, Diana Rosa Gonçalves, Nathalie Madeira, Cândida Silva, Eduardo Dourado, Raquel Freitas, Joana Rodrigues, Soraia Azevedo, Teresa Martins Rocha, Raquel Miriam Ferreira, Salomé Garcia, Bruno Miguel Fernandes, Ana Rita Prata, Maura Couto, Rita Pinheiro Torres, Inês Cunha, Lúcia Costa, Miguel Bernardes

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引用次数: 0

Abstract

Background: Remission/ low disease activity (LDA) are the main treatment goals in rheumatoid arthritis (RA) patients. Two tools showing the ability to predict golimumab treatment outcomes in patients with RA were published.

Objectives: To estimate the real-world accuracy of two quantitative tools created to predict RA remission and low disease activity.

Methods: Multicenter, observational study, using data from the Rheumatic Diseases Portuguese Register (Reuma.pt), including biologic naïve RA patients who started an anti-TNF as first-line biologic and with at least 6 months of follow-up. The accuracy of two matrices tools was assessed by likelihood-ratios (LR), sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve (AUC).

Results: 674 RA patients under first-line anti-TNF (266 etanercept, 186 infliximab, 131 adalimumab, 85 golimumab, 6 certolizumab pegol) were included. The median (IQR) age was 53.4 (44.7-61.1) years and the median disease duration was 7.7 (3.7-14.6) years. The majority were female (72%). Most patients were RF and/or ACPA positive (75.5%) and had erosive disease (54.9%); 58.6% had comorbidities. At 6-months, 157 (23.3%) patients achieved remission (DAS28 ESR < 2.6) and 269 (39.9%) LDA (DAS28 ESR ≤ 3.2). Area under the curve for remission in this real-world sample was 0.756 [IC 95% (0.713-0.799)] and for LDA was 0.724 [IC 95% (0.686 -0.763)]. The highest LR (8.23) for remission state was obtained at a cut-off ≥ 67%, with high specificity (SP) (99.6%) but low sensitivity (SN) (3.2%). A better balance of SN and SP (65.6% and 73.9%, respectively) was observed for a cut-off >30%, with a LR of 2.51, PPV of 43.3% and NPV of 87.6%.

Conclusion: In this population, the accuracy of the prediction tool was good for remission and LDA. Our results corroborate the idea that these matrix tools could be helpful to select patients for anti-TNF therapy.

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缓解和低疾病活动矩阵工具:抗tnf治疗下的现实世界类风湿性关节炎患者的结果。

背景:缓解/低疾病活动度(LDA)是类风湿性关节炎(RA)患者的主要治疗目标。发表了两种工具，显示了预测类风湿关节炎患者戈利姆单抗治疗结果的能力。目的:评估用于预测RA缓解和低疾病活动度的两种定量工具在现实世界中的准确性。方法:多中心观察性研究，使用风湿病葡萄牙登记册(Reuma.pt)的数据，包括生物制剂naïve RA患者，这些患者开始使用抗tnf作为一线生物制剂，并进行至少6个月的随访。采用似然比(LR)、敏感性(SN)、特异性(SP)、阳性预测值(PPV)、阴性预测值(NPV)和ROC曲线下面积(AUC)评价两种矩阵工具的准确性。结果:674例RA患者接受一线抗tnf治疗(依那西普266例，英夫利昔单抗186例，阿达木单抗131例，戈利木单抗85例，塞托单抗pegol 6例)。中位(IQR)年龄为53.4(44.7-61.1)岁，中位病程为7.7(3.7-14.6)年。大多数是女性(72%)。大多数患者为RF和/或ACPA阳性(75.5%)，并有糜烂性疾病(54.9%);58.6%有合并症。6个月时，157例(23.3%)患者达到缓解(DAS28 ESR < 2.6)， 269例(39.9%)患者达到LDA (DAS28 ESR≤3.2)。该真实样本的缓解曲线下面积为0.756 [IC 95% (0.713-0.799)]， LDA为0.724 [IC 95%(0.686 -0.763)]。在临界值≥67%时，缓解状态的最高LR(8.23)，具有高特异性(SP)(99.6%)和低敏感性(SN)(3.2%)。当临界值>30%时，SN和SP较好地平衡(分别为65.6%和73.9%)，LR为2.51,PPV为43.3%，NPV为87.6%。结论:在该人群中，预测工具对缓解和LDA的准确性较好。我们的结果证实了这些基质工具可能有助于选择抗tnf治疗的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta reumatologica portuguesa 医学-风湿病学

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Acta Reumatólogica Portuguesa is a scientific peer reviewed journal covering all aspects of rheumatic diseases and related to Rheumatology. The journal publishes original articles, reviews, clinical cases, images in rheumatology, letters to the editor and clinical teaching (e.g. guidelines and clinical protocols). Published since 1973, Acta Reumatológica Portuguesa is the official scientific publication of the Portuguese Society of Rheumatology, a non-profit organization that promotes the knowledge and investigation of rheumatic diseases and the development of Rheumatology.