Background Treat-to-target with intensification of therapy according to DAS28 is documented to be an effective strategy to manage rheumatoid arthritis (RA)1. However, DAS28 and CDAI require formal joint counts, which are not performed at most rheumatology visits. RAPID3, an index of only the 3 Core Data Set patient-reported outcomes (PROs), does not include a formal joint count, and is calculated on a multidimensional health assessment questionnaire (MDHAQ) in 5 seconds.
Objectives To compare changes for DAS28, CDAI, and RAPID3 from baseline to 6 months, and the proportions of patients in 4 categories for high, moderate, low activity/severity and remission at 6 months according to each index, in the GUEPARD treat-to-target clinical trial versus ESPOIR usual care cohort.
Methods Post-hoc analyses were performed on 2 databases: 65 RA patients from the GUEPARD tight control trial and 130 matched patients from the ESPOIR usual care cohort, all with baseline DAS28≥5.12. DAS28, CDAI, and RAPID3 were compared for mean changes from baseline to 6 months for differences between the two cohorts. The numbers and proportions of patients at 6 months in 4 categories: high, moderate, low activity/severity, and remission, were computed according to DAS28 >5.1, 3.2-5.1, 2.6-3.2, ≤2.6; CDAI >22, 10.1-22, 2.9-10, ≤2.8; RAPID3 >12, 6.1-12, 3.1-6, ≤3. Statistical significance was analyzed with Student’s t tests and kappa values.
Results Baseline demographic and clinical characteristics and DAS28, CDAI, and RAPID3, did not differ between study groups, other than disease duration (5.6 months in GUEPARD versus 3.5 months in ESPOIR); a higher percentage of GUEPARD patients took glucocorticoids, biological agents, and a higher mean dose of glucocorticoids. After 6 months, substantial improvement was seen in both groups. However, mean improvement was greater in GUEPARD compared to ESPOIR for each index: -3.3 vs -2.2 for DAS28, -29.5 versus -20.8 for CDAI and -12.1 vs -7.2 for RAPID3 (all p<0.0001). The percentage of patients in remission after 6 months was higher in GUEPARD (38-49%) versus ESPOIR (13-18%), similarly for the 3 indices (Table). Moderate agreement between CDAI and DAS28 (kappa=0.56) and between CDAI and RAPID3 (kappa=0.48), and fair agreement between DAS28 and RAPID3 (kappa=0.26) was seen.
Conclusions DAS28, CDAI and RAPID3 distinguish GUEPARD from ESPOIR similarly. Because of the moderate to low level of agreement between these instruments and in particular between the strict PRO one (e.g. RAPID3) and the composite indices including clinical evaluation of synovitis (e.g. DAS28), both evaluations might guide a treat to target strategy in daily practice.
Smolen J, et al. Ann Rheum Dis 2010;69: 631-637.
Soubrier M, et al. Ann Rheum Dis 2011;70:611-5.
Disclosure of Interest None Declared
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