Background Disease remission is a critical milestone in management of Rheumatoid Arthritis (RA). Both the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) have been working on refining the definition of remission in RA over the last several years; the influence of these efforts on physician practices in terms of consistency in definition of remission (as depicted by characteristics of patients identified to be in remission) within Europe (EU) and between EU and the United States (US) has not been evaluated.
Objectives To compare RA patients on disease remission in the EU and US among those receiving a biologic treatment as part of usual care.
Methods A multi-country multi-center medical chart-review study of RA patients was conducted in 4Q2011 among physicians (majority: rheumatologists) in hospitals/private practices to collect de-identified data on patients who were recently treated with a biologic as part of usual care. Physicians were screened for practice-duration and patient-volume and recruited from a large panel to be geographically representative in the EU (UK/Germany/France/Italy/Spain) and US. For each study-eligible patient chart, physicians abstracted patient diagnosis, treatment patterns/dynamics and patient symptomatology/disease status (incl. assessment of “disease remission”, per physician clinical judgment (both objective & subjective)). Patients on disease remission were analyzed.
Results Analysis included 1161 and 405 patients experiencing disease remission in the EU and US respectively; 75% (vs. 74%), 20% (vs. 22%) and 5% (vs. 4%) were on 1st line, 2nd line and ≥3rd line biologic respectively in the EU (vs. US). Mean duration in remission was: EU-12.2mo vs. US-12.1mo. Among those with lab measures, results were mostly similar between patients in remission in the EUvs.US: mean ESR (mm/h): 17.0 vs. 18.9, mean CRP (mg/dl): 7.0 vs. 1.6, Rheumatoid Factor (% positive): 83%vs.87% and Anti-CCP (% positive): 75%vs.74%. Among those with available data, recent (mean) disease severity scores were also similar between patients in remission in the EUvs.US: Tender Joint Count: 2.3 vs. 1.7, Swollen Joint Count: 1.2 vs. 0.8, 100mm VAS score: 18.6 vs. 18.9, HAQ: 0.7 vs. 0.6 and DAS28: 2.6 vs. 2.2.
Conclusions This is one of the first studies to compare RA patients in remission in the EU and US; the characteristics of these RA patients in remission were found mostly similar between these geographic clusters, despite the potential variations in healthcare systems and modalities of care delivery, possibly attributed by ACR/EULAR efforts in standardizing the outcome definitions and care delivery over the years.
Disclosure of Interest S. Narayanan Employee of: Ipsos, Y. Lu Employee of: Ipsos, R. Hutchings Employee of: Ipsos, A. Baskett Employee of: Ipsos
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