Background Significant improvements in disease activity and long term physical function have been documented following approval of biologic therapies for treatment of RA since 1998 [1, 2].
Objectives To determine if fewer RA patients now use relevant mechanical devices/aids (as listed in the Health Assessment Questionnaire [HAQ]) for performance of everyday physical activities compared to the earlier years.
Methods RA patients meeting the following criteria were included from the CORRONA registry (established in 2001): age >17 years at diagnosis with HAQ data and at least one-year follow up in the time period. Two specific cohorts were extracted: RA patients from years 2001–03 (emerging biologics era) and RA patients from years 2009–11 (mature biologics era). Differences in utilization of mechanical aids (specific list provided in table) over the years was examined through a multivariate logistic regression model including the use of mechanical aids (yes/no) as dependent variable and two cohorts as independent variable, adjusting for patient demographics (age, gender, education, employment, and marital status), disease characteristics (duration and severity of RA), and disease modifying anti-rheumatic drugs (DMARDs) use.
Results Of 4682 patients in the 2001-03 cohort, 1096 were eligible for analysis and 447 (40.8%) reported use of any mechanical aid. In the 2009-11 cohort 11,140 of 18,521 met criteria and 3466 (31.1%) used any mechanical aid. Despite similar demographics and disease duration [mean=10.7 and 11.6 years, respectively], disease activity measures including: mean CDAI scores [17.0 vs. 10.1], swollen joint counts [5.2 vs. 2.7], HAQ [0.9 vs. 0.7], patient pain [36.3 vs. 29.5], patient [34.3 vs. 27.4] and physician global assessment of disease activity [32.6 vs. 16.8] scores were significantly lower in the 2009-11 cohort (p<0.05). The percentage receiving DMARDs at baseline in 2001-03 vs. 2009-11 cohort were: 86.9 vs. 92.1%; biologic DMARDs: 32.5 vs. 50.7% and biologic naïve: 61.5 vs. 39.1%, respectively. In multivariate analysis, patients in 2009-11 cohort and with any history of biologics were found to have significantly lower odds of overall mechanical aids use (OR=0.77; 95% CI=0.66 to 0.90 and OR=0.68, 95% CI=0.62 to 0.75), respectively, Table. Similar findings were obtained for mechanical aids use over one year follow-up (data not shown).
Conclusions Mechanical aids/devices use was significantly lower during 2009-11 compared to 2001-03 and among patients with any history of biologics, indicating reduced impairment in physical function. Future studies are required to further examine the association of biologics with disability among RA patients.
Ziegler S, et al, Ann Rheum Dis 2010; 69:1803-1808. 2.Krishnan, E, et al. Ann Rheum Dis 71.2 (2012): 213-218.
Acknowledgements The CORRONA RA registry has been supported through contracted subscriptions in the last two years by Abbvie, Amgen, AstraZeneca, Genentech, Horizon Pharma, Eli Lilly, Novartis, Pfizer, Vertex and UCB. The design, study conduct, and financial support for the study was provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract.
Disclosure of Interest V. Strand Consultant for: CORRONA, Inc. and AbbVie, J. Greenberg Shareholder of: CORRONA, Inc., Consultant for: AstraZeneca, Pfizer, Employee of: CORRONA, Inc., Y. Bao Shareholder of: AbbVie, Employee of: AbbVie, K. Saunders Employee of: CORRONA, Inc., V. Garg Shareholder of: AbbVie, Employee of: AbbVie, G. Li Employee of: Axio Research LLC, A. Ganguli Shareholder of: AbbVie, Employee of: AbbVie