Examination of Patient-Reported Outcomes in Association with TNF-Inhibitor Treatment Response: Results from a US Observational Cohort Study

• Published in: Rheumatology and therapy. Vol. 5; no. 1; pp. 215 - 229
• Main Authors: Larmore, Cynthia J., Boytsov, Natalie N., Gaich, Carol L., Zhang, Xiang, Araujo, Andre B., Rebello, Sabrina, Salim, Bob A., Reed, George W., Harrold, Leslie R.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.06.2018; Springer Nature B.V
• Subjects: Clinical decision making; Clinical outcomes; Cohort analysis; Family Medicine; General Practice; Internal Medicine; Medicine; Medicine & Public Health; Observational studies; Original Research; Orthopedics; Patients; Quality of Life Research; Remission (Medicine); Rheumatism; Rheumatology; TNF inhibitors; Tumor necrosis factor-TNF; Rheumatoid; Health-related quality of life; Tumor necrosis factor-alpha; Arthritis; Clinical decision-making; Patient-reported outcome measures
• ISSN: 2198-6576; 2198-6584
• DOI: 10.1007/s40744-017-0092-0

Introduction Implementation of a treat-to-target strategy is challenging when the patient and physician prioritize different goals. This study aimed to “translate” improvements in Clinical Disease Activity Index (CDAI) to concepts that resonate with patients (such as pain, fatigue, morning stiffness) by examining the association between changes in disease activity and patient-reported outcomes (PROs) in a national cohort of patients with rheumatoid arthritis (RA) initiating their first biologic treatment. Methods Patients in the Corrona registry with moderate or high disease activity (M/HDA) (defined by a CDAI score > 10), prior use of at least one conventional synthetic disease-modifying antirheumatic drug (csDMARD), 12-month follow-up, and initiating their first tumor necrosis factor inhibitor (TNFi) between 1 January 2006 through 1 November 2015 were identified. Patients were stratified on the basis of CDAI during follow-up, and changes in PROs were compared with a test of trend using CDAI-defined groups. Results Of 1570 patients, 37% achieved sustained remission or low disease activity (remission/LDA), 15% had improving remission/LDA, 12% had worsening M/HDA, and 35% were in sustained M/HDA during 12-month follow-up. Those in sustained remission/LDA had greater magnitude of improvement in physical functioning, pain, fatigue, morning stiffness, patient’s global assessment, and quality of life compared with patients in sustained M/HDA ( p  < 0.001). Conclusion Reduction in disease activity was associated with improvements in PROs, with the greatest improvements seen in those who achieved sustained remission/LDA. These results reinforce the benefits of a treat-to-target approach to RA care and may improve dialogue between patients and providers, support shared decision-making, and reduce “clinical inertia.” Funding Corrona, LLC.