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

Ferreira, Ricardo J O; Welsing, Paco M J; Jacobs, Johannes W G; Gossec, Laure; Ndosi, Mwidimi; Machado, Pedro M; van der Heijde, D�sir�e; Da Silva, Jose A P

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


Authors

Ricardo J O Ferreira

Paco M J Welsing

Johannes W G Jacobs

Laure Gossec

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Dr Mwidimi Ndosi Mwidimi.Ndosi@uwe.ac.uk
Associate Professor in Nursing Rheumatology

Pedro M Machado

D�sir�e van der Heijde

Jose A P Da Silva



Abstract

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.

Citation

Ferreira, R. J. O., Welsing, P. M. J., Jacobs, J. W. G., Gossec, L., Ndosi, M., Machado, P. M., …Da Silva, J. A. P. (2021). Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: An individual meta-analysis of 5792 patients. Annals of the Rheumatic Diseases, 80(3), 277-279. https://doi.org/10.1136/annrheumdis-2020-217171

Journal Article Type Article
Acceptance Date Sep 3, 2020
Online Publication Date Oct 6, 2020
Publication Date Feb 11, 2021
Deposit Date Oct 7, 2020
Publicly Available Date Mar 28, 2024
Journal Annals of the Rheumatic Diseases
Print ISSN 0003-4967
Electronic ISSN 1468-2060
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 80
Issue 3
Pages 277-279
DOI https://doi.org/10.1136/annrheumdis-2020-217171
Keywords Immunology; General Biochemistry, Genetics and Molecular Biology; Immunology and Allergy; Rheumatology
Public URL https://uwe-repository.worktribe.com/output/6758115
Publisher URL https://ard.bmj.com/content/early/2020/10/06/annrheumdis-2020-217171

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