Multi-biomarker disease activity score as a predictor of disease relapse in patients with rheumatoid arthritis stopping TNF inhibitor treatment

Abstract

ObjectiveSuccessfully stopping or reducing treatment for patients with rheumatoid arthritis (RA) in low disease activity (LDA) may improve cost-effectiveness of care. We evaluated the multi-biomarker disease activity (MBDA) score as a predictor of disease relapse after discontinuation of TNF inhibitor (TNFi) treatment.Methods439 RA patients who were randomized to stop TNFi treatment in the POET study were analyzed post-hoc. Three indicators of disease relapse were assessed over 12 months: 1) restarting TNFi treatment, 2) escalation of any DMARD therapy and 3) physician-reported flare. MBDA score was assessed at baseline. Associations between MBDA score and disease relapse were examined using univariate analysis and multivariate logistic regression.ResultsAt baseline, 50.1%, 35.3% and 14.6% of patients had low (<30), moderate (30−44) or high (>44) MBDA scores. Within 12 months, 49.9% of patients had restarted TNFi medication, 59.0% had escalation of any DMARD and 57.2% had ≥1 physician-reported flare. MBDA score was associated with each indicator of relapse. At least one indicator of relapse was observed in 59.5%, 68.4% and 81.3% of patients with low, moderate or high MBDA scores, respectively (P = 0.004). Adjusted for baseline DAS28-ESR, disease duration, BMI and erosions, high MBDA scores were associated with increased risk for restarting TNFi treatment (OR = 1.85, 95% CI 1.00–3.40), DMARD escalation (OR = 1.99, 95% CI 1.01–3.94) and physician-reported flare (OR = 2.00, 95% 1.06–3.77).ConclusionFor RA patients with stable LDA who stopped TNFi, a high baseline MBDA score was independently predictive of disease relapse within 12 months. The MBDA score may be useful for identifying patients at risk of relapse after TNFi discontinuation.

A multi-biomarker disease activity score can predict sustained remission in rheumatoid arthritis

“…In RETRO, a study of RA patients in stable remission who underwent tapering of all DMARDs simultaneously, baseline MBDA scores in the moderate or high category were significantly associated with a higher relapse rate [26]. In POET, a study of RA patients in stable low disease activity/remission who discontinued anti-TNF treatment, a high baseline MBDA score was independently predictive of disease relapse within 12 months [27]. By contrast, MBDA score at baseline was not associated with flare following treatment reduction in the DRESS [25] or STRASS studies [28].…”

“…As expected, the median DAS28-ESR, DAS28-CRP, SDAI and CDAI at baseline (2.08, 2.50, 4.1 and 3.7, respectively) were all in the low category. The median (IQR) baseline MBDA score was 31 (18-39) and the median tiMBDA score was 29 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). The heatmap in Fig.…”

Neopterin serum level does not reflect the disease activity in rheumatoid arthritis: A systematic review and meta‐analysis

“…2 Measurement of RA disease activity is quite substantial to opt for proper treatment; furthermore, the need for monitoring the effectiveness of disease-modifying antirheumatic drug therapy highlights the importance of disease activity surveillance. 3 Several criteria have been designed for assessment of RA disease activity, including Disease Activity Score in 28 joints (diseases activity score [DAS]-28), Simplified Disease Activity Index, Clinical Disease Activity Index, Rheumatoid Arthritis Disease Activity Index, Patient Activity Scale (PAS or PASII), and Routine Assessment Patient Index Data. 4 DAS-28 is a wellestablished tool for discrimination of patients in the remission phase as well as patients with low, moderate, and high disease activity.…”

“…Since none of the current treatment modalities cure RA, a state of clinical remission is the most important consideration and overriding goal in the management of RA, which could not be met without evaluation of disease activity 2 . Measurement of RA disease activity is quite substantial to opt for proper treatment; furthermore, the need for monitoring the effectiveness of disease‐modifying anti‐rheumatic drug therapy highlights the importance of disease activity surveillance 3 . Several criteria have been designed for assessment of RA disease activity, including Disease Activity Score in 28 joints (diseases activity score [DAS]‐28), Simplified Disease Activity Index, Clinical Disease Activity Index, Rheumatoid Arthritis Disease Activity Index, Patient Activity Scale (PAS or PASII), and Routine Assessment Patient Index Data 4 .…”

Two-year Outcomes of Infliximab Discontinuation in Patients with Rheumatoid Arthritis: A Retrospective Analysis from a Single Center

“…Recently, the multi-biomarker disease activity (MBDA) has received attention as reflecting the current disease activity along with changes and the treatment response ( 9 ). Futhermore, the MBDA was also reported to be a potential predictor of flare after the discontinuation of TNF inhibitors ( 10 ). While the measurement of biomarkers included in the MBDA remains relatively uncommon and data are lacking at present, such objective predictors are expected to be established in the future.…”