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
{"title":"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。","authors":"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","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>To estimate the real-world accuracy of two quantitative tools created to predict RA remission and low disease activity.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":7229,"journal":{"name":"Acta reumatologica portuguesa","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Remission and low disease activity matrix tools: results in real-world rheumatoid arthritis patients under anti-TNF therapy.\",\"authors\":\"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\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>To estimate the real-world accuracy of two quantitative tools created to predict RA remission and low disease activity.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":7229,\"journal\":{\"name\":\"Acta reumatologica portuguesa\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2020-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta reumatologica portuguesa\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta reumatologica portuguesa","FirstCategoryId":"3","ListUrlMain":"","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Remission and low disease activity matrix tools: results in real-world rheumatoid arthritis patients under anti-TNF therapy.
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.
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.
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