Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Patients with Early Rheumatoid Arthritis Determined to Be Inadequate Responders After 12 Weeks May Still Have Substantial Improvement in Core Set Measures. Results from an Early Arthritis Cohort.
Akhavan1, Pooneh S., Bykerk2, Vivian, Sun3, Ye, Boire4, Gilles, Thorne5, J. Carter, Pope6, Janet, Hitchon7, Carol A.
University of Toronto, Toronto, ON
Brigham & Women's Hospital, Boston, MA
Mount Sinai Hospital, Toronto, ON
CHUS - Sherbrooke University, Sherbrooke, QC
Southlake Regional Health Centre, Newmarket, Newmarket, ON
Univ of Western Ontario, London, ON
University of Manitoba, Winnipeg, MB
Institut de Rhumatologie, Montreal, QC
ACR or EULAR response criteria have been used in trials and also in routine clinical practice to guide treatment decisions in RA. Patients who fail to achieve DDAS28 >=1.2 or ACR20 are generally considered inadequate responders.To evaluate clinical improvement in individual core set measures in patients considered inadequate responders using DAS28 and ACR composite measures of disease activity.
Patients with early RA who were enrolled and prospectively followed in the Canadian Early Arthritis Cohort (CATCH) were studied. Patients receiving DMARD therapy for 3 months who failed to achieve DDAS28 >= 0.6, DDAS28 >= 1.2 or ACR20 were examined for 20% and 30% improvement in their disease activity core set measures.
416 patients with mean age 52.5 yr (14.3)(SD), disease duration 6.1 mo (3.0), Tender Joint Count (TJC) 9.2 (7.1), Swollen Joint Count (SJC) 8.2 (6.2) and DAS28 5.1(1.6) at baseline were included in this analysis. At 3 months 197(47%) patients had not achieved ACR20, 304 (73%) had not achieved ACR50 and 348 (84%) had not achieved ACR70. Half of included patients had DAS28 improvement < 1.2 and in 142 (34%) patients DAS28 improvement was < 0.6 at 3 months. About a third of patients with DDAS28 < 0.6 had 30% improvement in TJC, SJC, patient and physician global. This proportion varied from 30% to 44% in patients with DDAS28 < 1.2 and from 2041% in patients who did not achieve ACR20. Mean core set measure improvement in patients with DAS28<0.6 was found to vary from 18% (patients global) to 26% (SJC). Thirty seven percent of patients with DDAS28< 0.6 achieved HAQ Minimal Clinically Improvement (MCID)[0.22]. This proportion was 42% for patients with DDAS28<1.2 or 35% in patients who failed to achieve ACR20.
A substantial proportion of patients who fail to achieve a significant improvement in composite measures of disease activity frequently used in clinical studies may still exhibit substantial improvement in their individual core set measures. These findings should be considered when making treatment decisions in real world clinical settings and identifying patients with an inadequate clinical response.
To cite this abstract, please use the following information:
Akhavan, Pooneh S., Bykerk, Vivian, Sun, Ye, Boire, Gilles, Thorne, J. Carter, Pope, Janet, et al; Patients with Early Rheumatoid Arthritis Determined to Be Inadequate Responders After 12 Weeks May Still Have Substantial Improvement in Core Set Measures. Results from an Early Arthritis Cohort. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :339