Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment : an individual meta-analysis of 5792 patients

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OBJECTIVES: To determine the impact of excluding patient global assessment (PGA) from the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission criteria, on prediction of radiographic and functional outcome of rheumatoid arthritis (RA).

METHODS: Meta-analyses using individual patient data from randomised controlled trials testing the efficacy of biological agents on radiographic and functional outcomes at ≥2 years. Remission states were defined by 4 variants of the ACR/EULAR Boolean definition: (i) tender and swollen 28-joint counts (TJC28/SJC28), C reactive protein (CRP, mg/dL) and PGA (0-10=worst) all ≤1 (4V-remission); (ii) the same, except PGA >1 (4V-near-remission); (iii) 3V-remission (i and ii combined; similar to 4V, but without PGA); (iv) non-remission (TJC28 >1 and/or SJC28 >1 and/or CRP >1). The most stringent class achieved at 6 or 12 months was considered. Good radiographic (GRO) and functional outcome (GFO) were defined as no worsening (ie, change in modified total Sharp score (ΔmTSS) ≤0.5 units and ≤0.0 Health Assessment Questionnaire-Disability Index points, respectively, during the second year). The pooled probabilities of GRO and GFO for the different definitions of remission were estimated and compared.

RESULTS: Individual patient data (n=5792) from 11 trials were analysed. 4V-remission was achieved by 23% of patients and 4V-near-remission by 19%. The probability of GRO in the 4V-near-remission group was numerically, but non-significantly, lower than that in the 4V-remission (78 vs 81%) and significantly higher than that for non-remission (72%; difference=6%, 95% CI 2% to 10%). Applying 3V-remission could have prevented therapy escalation in 19% of all participants, at the cost of an additional 6.1%, 4.0% and 0.7% of patients having ΔmTSS >0.0, >0.5 and >5 units over 2 years, respectively. The probability of GFO (assessed in 8 trials) in 4V-near-remission (67%, 95% CI 63% to 71%) was significantly lower than in 4V-remission (78%, 74% to 81%) and similar to non-remission (69%, 66% to 72%).

CONCLUSION: 4V-near-remission and 3V-remission have similar validity as the original 4V-remission definition in predicting GRO, despite expected worse prediction of GFO, while potentially reducing the risk of overtreatment. This supports further exploration of 3V-remission as the target for immunosuppressive therapy complemented by patient-oriented targets.

Errataetall:	CommentIn: Ann Rheum Dis. 2021 Mar;80(3):277-279. - PMID 33158884
Medienart:	E-Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:80
Enthalten in:	Annals of the rheumatic diseases - 80(2021), 3 vom: 15. März, Seite 293-303

Sprache:	Englisch

Beteiligte Personen:	Ferreira, Ricardo J O [VerfasserIn] Welsing, Paco M J [VerfasserIn] Jacobs, Johannes W G [VerfasserIn] Gossec, Laure [VerfasserIn] Ndosi, Mwidimi [VerfasserIn] Machado, Pedro M [VerfasserIn] van der Heijde, Désirée [VerfasserIn] Da Silva, Jose A P [VerfasserIn]

Links:	Volltext

Themen:	9007-41-4 Antirheumatic Agents C-Reactive Protein Disease activity Inflammation Journal Article Meta-Analysis Outcomes research Patient perspective Research Support, Non-U.S. Gov't Rheumatoid arthritis

Anmerkungen:	Date Completed 30.12.2022 Date Revised 30.12.2022 published: Print-Electronic CommentIn: Ann Rheum Dis. 2021 Mar;80(3):277-279. - PMID 33158884 Citation Status MEDLINE

doi:	10.1136/annrheumdis-2020-217171

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM315941456