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Impact of discordance between patient

Author

Michelsen B1,2,3, Ørnbjerg LM1,4, Kvien TK3, Pavelka K5, Nissen MJ6, Nordström D7, Santos MJ8, Koca SS9, Askling J10, Rotar Z11, Gudbjornsson B12, Codreanu C13, Loft AG4,14, Kristianslund EK4, Mann HF5, Ciurea A15, Eklund KK16, Vieira-Sousa E8, Yazici A17, Jacobsson L18, Tomšic M11, Löve TJ19, Ionescu R13, van der Horst-Bruinsma IE20, Iannone F21, Pombo-Suarez M22, Jones GT23, Hyldstrup LH1, Krogh NS24, Hetland ML1,25, Østergaard M1,25. Rheumatology (Oxford). 2020 Jan 20. pii: kez656. doi: 10.1093/rheumatology/kez656. [Epub ahead of print]

Author Information

1 EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.

2 Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand.

3 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.

4 DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.

5 Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.

6 Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland.

7 ROB-FIN Registry, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

8 Reuma.pt Registry and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal.

9 TURKBIO Registry and Division of Rheumatology, School of Medicine, Firat University, Elazig, Turkey.

10 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

11 BioRx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.

12 Centre for Rheumatology Research (ICEBIO), University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

13 Center of Rheumatic Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania.

14 Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.

15 Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.

16 Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland.

17 TURKBIO Registry and Division of Rheumatology, School of Medicine, Kocaeli University, Izmit, Turkey.

18 Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

19 University of Iceland, Faculty of Medicine, Landspitali University Hospital, Reykjavik, Iceland.

20 Department Rheumatology & Immunology Center (ARC), Amsterdam University Medical Centres, Location VU University Medical Centre, Amsterdam, the Netherlands.

21 GISEA Registry, Rheumatology Unit - DETO, University of Bari, Italy.

22 Rheumatology Service, Hospital Clinico Universitario, Santiago de Compostela, Spain.

23 Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK.

24 Zitelab Aps, Copenhagen, Denmark.

 

Abstract

OBJECTIVES: 

To assess the impact of 'patient's minus evaluator's global assessment of disease activity' (ΔPEG) at treatment initiation on retention and remission rates of TNF inhibitors (TNFi) in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients across Europe.

METHODS: 

Real-life data from PsA and axSpA patients starting their first TNFi from 11 countries in the European Spondyloarthritis Research Collaboration Network were pooled. Retention rates were compared by Kaplan-Meier analyses with log-rank test and by Cox regression, and remission rates by χ2 test and by logistic regression across quartiles of baseline ΔPEG, separately in female and male PsA and axSpA patients.

RESULTS: 

We included 14 868 spondyloarthritis (5855 PsA, 9013 axSpA) patients. Baseline ΔPEG was negatively associated with 6/12/24-months' TNFi retention rates in female and male PsA and axSpA patients (P <0.001), with 6/12/24-months' BASDAI < 2 (P ≤0.002) and ASDAS < 1.3 (P ≤0.005) in axSpA patients, and with DAS28CRP(4)<2.6 (P ≤0.04) and DAPSA28 ≤ 4 (P ≤0.01), but not DAS28CRP(3)<2.6 (P ≥0.13) in PsA patients, with few exceptions on remission rates. Retention and remission rates were overall lower in female than male patients.

CONCLUSION: 

High baseline patient's compared with evaluator's global assessment was associated with lower 6/12/24-months' remission as well as retention rates of first TNFi in both PsA and axSpA patients. These results highlight the importance of discordance between patient's and evaluator's perspective on disease outcomes.