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Clinical Rheumatology

, Volume 32, Issue 5, pp 665–670 | Cite as

A predictive model for remission and low disease activity in patients with established rheumatoid arthritis receiving TNF blockers

  • Cristina Pomirleanu
  • Codrina AncutaEmail author
  • Smaranda Miu
  • Rodica Chirieac
Brief Report
First Online:

Abstract

The objective of this study was to identify predictors for remission or low disease activity (LDA) in established rheumatoid arthritis (RA) at 12 months of anti-TNF-α therapy. We have performed a prospective observational study in 90 consecutive patients with active RA receiving TNF-α inhibitors. Baseline and standard assessments were done every 3 months, including individual parameters (clinical and biological) and composite activity scores (28-joint disease activity score, DAS28). The primary outcome measure was DAS28-based EULAR response criteria. The multivariate logistic regression was used to analyze the association between disease activity and several RA baseline characteristics. Of the RA, 78.8 % was classified as good responders based on the EULAR-DAS28 criteria, 44.4 % RA achieving remission (DAS28 ≤ 2.6) and 34.4 %, LDA (DAS28 ≤ 3.2). Parameters associated with an increased likelihood of remission and LDA were initial DAS28-erythrocyte sedimentation rate ≤7 (odds ratio (OR) 3.3, 95 % confidence interval (CI) 2.03–5.81; OR 1.8, 95 % CI 1.09–6.68), Health Assessment Questionnaire Disability Index ≤ 2 (OR 7.0, 95 % CI 1.56–31.91; OR 1.3, 95 % CI 1.03–5.79), C-reactive protein level ≤20 mg/l (OR 1.5, 95 % CI 0.29–8.22; OR 0.5, 95 % CI0.08–2.97), rheumatoid factor ≤20 IU/ml (OR 18.9, 95 % CI 10.79–38.36; OR 32.9, 95 % CI 4.03–269), anti-cyclic citrullinated peptide antibodies ≤40 IU/ml (OR 3.5, 95 % CI 0.67–18.19; OR 1.2, 95 % CI 1.02–1.59), concurrent prednisolone (OR 0.2, 95 % CI 0.05–0.36; OR 0.2, 95 % CI 0.06–0.63), methotrexate or leflunomide (OR 1.6, 95 % CI 1.2–13.53; OR 2.9, 95 % CI 1.20–4.36). A predictive matrix for remission and LDA in established active RA patients receiving TNF-α inhibitors was proposed. Further studies are necessary to confirm the value of such matrix in particular RA settings, leading to optimization of the use of anti-TNF-α therapy.

Keywords

Anti-TNF-α agents Established rheumatoid arthritis Low disease activity Predictors Remission 
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Notes

Disclosures

None.

References

  1. 1.
    Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, Davenport G, Fokke C, Goodson N, Jeffreson P, Lamb E, Mohammed R, Oliver S, Stableford Z, Walsh D, Washbrook C, Webb F, British Society for Rheumatology, British Health Professionals in Rheumatology Standards Guidelines and Audit Working Group (2006) British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (the first two years). Rheumatology (Oxford) 45:1167–1169CrossRefGoogle Scholar
  2. 2.
    Bykerk V, Keystone E (2005) What are the goals and principles of management in the early treatment of rheumatoid arthritis. Best Pract Res ClinRheumatol 19:147–161CrossRefGoogle Scholar
  3. 3.
    Fransen J, Moens HB, Speyer I, van Riel PL (2005) Effectiveness of systematic monitoring of rheumatoid arthritis disease activity in daily practice: a multicentre, cluster randomized controlled trial. Ann Rheum Dis 64:1294–1298PubMedCrossRefGoogle Scholar
  4. 4.
    Verstappen SM, Jacobs JW, van der Veen MJ, Heurkens AH, Schenk Y, ter Borg EJ et al (2007) Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer assisted management in early rheumatoid arthritis (camera, an open-label strategy trial). Ann Rheum Dis 66:1443–1449PubMedCrossRefGoogle Scholar
  5. 5.
    Miossec P, Verweij CL, Klareskog L, Pitzalis C, Barton A, Lekkerkerker F et al (2011) Group for respect of ethics and excellence in science (grees). Biomarkers and personalized medicine in rheumatoid arthritis: a proposal for interactions between academia, industry and regulatory bodies. Ann Rheum Dis 70(10):1713–1718PubMedCrossRefGoogle Scholar
  6. 6.
    Chen YF, Jobanputra P, Barton P, Jowett S, Bryan S, Clark W et al (2006) A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Health Technol Assess 10:1–229, iii–iv, xi–xiiiGoogle Scholar
  7. 7.
    Marotte H, Miossec P (2010) Biomarkers for prediction of TNFα blockers response in rheumatoid arthritis. Joint Bone Spine 77:297–05PubMedCrossRefGoogle Scholar
  8. 8.
    Mader R, Keystone E (2007) Optimizing treatment with biologics. J Rheumatol Suppl 80:16–24PubMedGoogle Scholar
  9. 9.
    Erickson AR, Mikuls TR (2007) Switching anti–TNF-alpha agents: what is the evidence. CurrRheumatol Rep 9(5):416–420CrossRefGoogle Scholar
  10. 10.
    Bolosiu H, Ionescu R, Chirieac R, Georgescu L, Rednic S, Suta M, et al. (2011) Ghidul de tratament al poliartriteireumatoide. RevistaRomană de Reumatologie vol. xx nr. 1; 36–53.Google Scholar
  11. 11.
    van Gestel AM, Prevoo ML, van Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL (1996) Development and validation of the European League against rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism criteria. Arthritis Rheum 39:34–40PubMedCrossRefGoogle Scholar
  12. 12.
    Katchamart W, Johnson S, Lin H, Phumethum V, Salliot C, Bombardier C (2010) Predictors for remission in rheumatoid arthritis patients: a systematic review. Arthritis Care Res 62:1128–1143CrossRefGoogle Scholar
  13. 13.
    Vazquez I, Graell E, Gratacos J, Canete JD, Vinas O, Ercilla MG et al (2007) Prognostic markers of clinical remission in early rheumatoid arthritis after two years of DMARDs in a clinical setting. ClinExpRheumatol 25:231–238Google Scholar
  14. 14.
    Forslind K, Hafstrom I, Ahlmen M, Svensson B (2007) The BARFOT Study Group. Sex: a major predictor of remission in early rheumatoid arthritis. Ann Rheum Dis 66:46–52PubMedCrossRefGoogle Scholar
  15. 15.
    Burmester GR, Ferraccioli G, Flipo RM, Monteagudo-Saez I, Unnebrink K, Kary S et al (2008) Clinical remission and/or minimal disease activity in patients receiving adalimumab treatment in a multinational, open-label, twelve-week study. Arthritis Rheum 59:32–41PubMedCrossRefGoogle Scholar
  16. 16.
    Kristensen LE, Kapetanovic MC, Gulfe A, Soderlin M, Saxne T, Geborek P (2008) Predictors of response to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA: results from the South Swedish arthritis treatment group register. Rheumatology (Oxford) 47:495–499CrossRefGoogle Scholar
  17. 17.
    Verstappen SM, van Albada-Kuipers GA, Bijlsma JW, Blaauw AA, Schenk Y, Haanen HC et al (2005) A good response to early DMARD treatment of patients with rheumatoid arthritis in the first year predicts remission during follow up. Ann Rheum Dis 64:38–43PubMedCrossRefGoogle Scholar
  18. 18.
    Mancarella L, Bobbio-Pallavicini F, Ceccarelli F, Falappone PC, Ferrante A, Malesci D et al (2007) Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-α blockers: the GISEA study. J Rheumatol 34:1670–1673PubMedGoogle Scholar
  19. 19.
    Mottonen T, Hannonen P, Korpela M, Nissila M, Kautiainen H, Ilonen J (2002) For the FIN-RACo Trial Group. Delay to institution of therapy and induction of remission using singledrug or combination–disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 46:894–898PubMedCrossRefGoogle Scholar
  20. 20.
    Hyrich KL, Watson KD, Silman AJ, Symmons DP, British Society for Rheumatology Biologics Register (2006) Predictors of response to anti-TNF-α therapy among patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 45:1558–1565CrossRefGoogle Scholar
  21. 21.
    Van der Heijde D, Klareskog L, Landewe R, Bruyn GA, Cantagrel A, Durez P (2007) For the TEMPO Study Investigators. Disease remission and sustained halting of radiographic progression with combination etanercept and methotrexate in patients with rheumatoid arthritis. Arthritis Rheum 56:3928–3939PubMedCrossRefGoogle Scholar
  22. 22.
    Molenaar ET, Voskuyl AE, van der Horst-Bruinsma IE, Schreuder GM, Zanelli E, Dijkmans BA (2002) Influence of HLA polymorphism on persistent remission in rheumatoid arthritis. Ann Rheum Dis 61:351–353PubMedCrossRefGoogle Scholar
  23. 23.
    Hyrich KL, Symmons DP, Watson KD, Silman AJ, British Society for Rheumatology Biologics Register (2006) Comparison of the response to infliximab or etanerceptmonotherapy with the response to cotherapy with methotrexate or another disease-modifying antirheumatic drug in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 54:1786–1794PubMedCrossRefGoogle Scholar
  24. 24.
    Liang GC, Cordero M, Dyer A, Chang RW (2005) Current tumor necrosis factor-α inhibitor use is associated with a higher probability of remissions in patients with rheumatoid arthritis. J Rheumatol 32:1662–1665PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • Cristina Pomirleanu
    • 1
    • 2
  • Codrina Ancuta
    • 1
    • 2
    Email author
  • Smaranda Miu
    • 1
    • 2
  • Rodica Chirieac
    • 1
    • 2
  1. 1.University of Medicine and Pharmacy “Gr. T. Popa”IasiRomania
  2. 2.Clinical Rehabilitation HospitalIasiRomania

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