Background The prediction of radiographic progression in early rheumatoid arthritis (eRA) patients is important for optimal treatment. We previously demonstrated that a multi-biomarker disease activity (MBDA) score at baseline (BL) was predictive for radiographic progression over the first year of treatment.
Objectives To evaluate the MBDA score at different time-points and its change during treatment as a predictor of radiographic progression over the first two years of treatment in eRA.
Methods The analyses were performed on radiographic progression of patients from the SWEFOT trial, assessed by van der Heijde modified Sharp scores (SHS) from BL to years 1 and 2 (n=220) and from year 1 to year 2 (n=133); and on the MBDA & disease activity scores (DAS28) and C-reactive protein (CRP) at BL (n=220), month 3 (n=220 & n=205) and year 1 (n=133). Radiographic progression was defined as ΔSHS>5. Mann-Whitney U and Chi-square tests were used for comparisons of disease activity measures between progressors and non-progressors, and for determining significance of proportion of radiographic progressors.
Results The median values of MBDA score, CRP (mg/L) and DAS28 at BL for progressors (n=41) and non-progressors (n=179) were 70 and 58 (p=0.001), 28 and 18 (p=0.049), and 6.1 and 5.7 (p=0.136), respectively. After 3 months of MTX therapy the corresponding values were 48 and 40 (p=0.001), 9 and 9 (p=0.213), and 4.8 and 4.0 (p=0.009), respectively. At each time-point patients with low MBDA score had a lower mean ΔSHS and a smaller proportion of subsequent radiographic progressors than those with low CRP or low DAS28 (table).
The highest risk for progression from BL to year 1 or 2 (25% and 42% respectively), or from year 1 to year 2 (36%), was observed among patients with high MBDA score at BL which remained high at 3 or 12 months. In contrast, patients with high MBDA score at BL and low MBDA score at months 3 or 12 had much lower risk for progression (6%, 18% and 4% respectively). All patients with persistent low MBDA score throughout 1 year did not progress radiographically over 2 years. Those who had a moderate MBDA score at BL and achieved low MBDA at months 3 or 12 did not progress either.
Conclusions MBDA scores at BL and at 3 & 12 months of treatment, as well as change in MBDA category were predictive of subsequent radiographic progression during up to 2 years. At all measured time points a low MBDA score or achievement of the latter was associated with low risk for subsequent x-ray progression.
Disclosure of Interest K. Hambardzumyan: None declared, R. Bolce Shareholder of: Crescendo Bioscience, Employee of: Crescendo Bioscience, S. Saevarsdottir: None declared, K. Forslind: None declared, I. Petersson Speakers bureau: UCB Pharma, Pfizer, AbbVie, P. Geborek: None declared, S. Ernestam: None declared, E. Sasso Shareholder of: Crescendo Bioscience, Employee of: Crescendo Bioscience, D. Chernoff Shareholder of: Crescendo Bioscience, Consultant for: Crescendo Bioscience, S. Cruickshank Consultant for: Crescendo Bioscience, R. Van Vollenhoven Grant/research support: Abb Vie, BMS, GSK, Pfizer, Roche, UCB, Consultant for: AbbVie, Biotest, BMS, Crescendo Bioscience, GSK, Janssen, Lilly, Merck, Pfizer, Roche, UCB, Vertex