Predictive value of a multi-biomarker disease activity score for clinical remission and radiographic progression in patients with early rheumatoid arthritis: a post-hoc study of the OPERA trial

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  • C H Brahe, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark., Department of Clinical Medicine, University of Copenhagen, The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
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  • M Østergaard, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark., Department of Clinical Medicine, University of Copenhagen, The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
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  • J S Johansen, Departments of Oncology and Medicine, Copenhagen University Hospital, Herlev, Denmark.
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  • N Defranoux, e Crescendo Bioscience Inc ., San Francisco , CA , USA.
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  • X Wang, e Crescendo Bioscience Inc ., San Francisco , CA , USA.
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  • R Bolce, e Crescendo Bioscience Inc ., San Francisco , CA , USA.
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  • E H Sasso, e Crescendo Bioscience Inc ., San Francisco , CA , USA.
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  • L M Ørnbjerg, The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
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  • K Hørslev-Petersen, King Christian X’s Hospital for Rheumatic Diseases, Graasten
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  • K Stengaard-Pedersen
  • P Junker, Reumatologisk Afdeling, Odense Universitetshospital
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  • T Ellingsen
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  • P Ahlquist, Medicinsk Afdeling, Sygehus Lillebælt, Vejle
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  • H Lindegaard, Reumatologisk Afdeling, Odense Universitetshospital
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  • A Linauskas
  • A Schlemmer
  • M Y Dam
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  • I Hansen
  • T Lottenburger, Medicinsk Afdeling, Sygehus Lillebælt, Vejle
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  • C Ammitzbøll
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  • A Jørgensen
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  • S B Krintel, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark., The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
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  • J Raun, King Christian X’s Hospital for Rheumatic Diseases, Graasten
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  • M L Hetland, The DANBIO Registry, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark., Department of Clinical Medicine, University of Copenhagen

OBJECTIVES: Measurement of serum biomarkers at disease onset may improve prediction of disease course in patients with early rheumatoid arthritis (RA). We evaluated the multi-biomarker disease activity (MBDA) score and early changes in MBDA score for prediction of 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP) remission and radiographic progression in the double-blinded OPERA trial.

METHOD: Treatment-naïve RA patients (N = 180) with moderate or high DAS28 were randomized to methotrexate (MTX) + adalimumab (n = 89) or MTX + placebo (n = 91) in combination with glucocorticoid injection into swollen joints. X-rays of hands and feet were evaluated at months 0 and 12 (n = 164) by the total Sharp van der Heijde score (TSS). The smallest detectable change (1.8 TSS units) defined radiographic progression (∆TSS ≥ 2). Clinical remission (DAS28-CRP < 2.6) was assessed at baseline and 6 months. MBDA score was determined at 0 and 3 months and tested in a multivariable logistic regression model for predicting DAS28 remission at 6 months and radiographic progression at 1 year.

RESULTS: Baseline MBDA score was independently associated with radiographic progression at 1 year [odds ratio (OR) = 1.03/unit, 95% confidence interval (CI) = 1.01-1.06], and changes in MBDA score from baseline to 3 months with clinical remission at 6 months [OR = 0.98/unit, 95% CI 0.96-1.00). In anti-cyclic citrullinated peptide antibody (anti-CCP)-positive patients, 35 of 89 with high MBDA score (> 44) showed radiographic progression (PPV = 39%), compared with 0 of 15 patients (NPV = 100%) with low/moderate MBDA score (≤ 44) (p = 0.003).

CONCLUSION: Early changes in MBDA score were associated with clinical remission based on DAS28-CRP at 6 months. In anti-CCP-positive patients, a non-high baseline MBDA score (≤ 44) had a clinical value by predicting very low risk of radiographic progression at 12 months.

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Rheumatology
Vol/bind48
Nummer1
Sider (fra-til)9-16
Antal sider8
ISSN0300-9742
DOI
StatusUdgivet - 2019

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