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  • Pretreatment multi-biomarker disease activity score and radiographic progression in early RA: results from the SWEFOT trial

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Clinical and epidemiological research
Extended report
Pretreatment multi-biomarker disease activity score and radiographic progression in early RA: results from the SWEFOT trial
  1. Karen Hambardzumyan1,
  2. Rebecca Bolce2,
  3. Saedis Saevarsdottir1,3,
  4. Scott E Cruickshank4,
  5. Eric H Sasso2,
  6. David Chernoff2,
  7. Kristina Forslind5,6,
  8. Ingemar F Petersson5,7,
  9. Pierre Geborek5,
  10. Ronald F van Vollenhoven1
  1. 1Unit of Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden
  2. 2Crescendo Bioscience Inc., South San Francisco, California, USA
  3. 3Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
  4. 4Scott Cruickshank and Associates Inc., Santa Barbara, California, USA
  5. 5Section of Rheumatology, Institution of Clinical Sciences, University Hospital, Lund, Sweden
  6. 6Section of Rheumatology, Department of Medicine, Helsingborg Hospital, Helsingborg, Sweden
  7. 7Department of Orthopaedics, Institution of Clinical Sciences, Lund University, Lund, Sweden
  1. Correspondence to Karen Hambardzumyan, Department of Medicine, Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, D1:00 Karolinska University Hospital, Solna, Stockholm 17176, Sweden; karen.hambardzumyan{at}ki.se

Abstract

Objectives Prediction of radiographic progression (RP) in early rheumatoid arthritis (eRA) would be very useful for optimal choice among available therapies. We evaluated a multi-biomarker disease activity (MBDA) score, based on 12 serum biomarkers as a baseline predictor for 1-year RP in eRA.

Methods Baseline disease activity score based on erythrocyte sedimentation rate (DAS28-ESR), disease activity score based on C-reactive protein (DAS28-CRP), CRP, MBDA scores and DAS28-ESR at 3 months were analysed for 235 patients with eRA from the Swedish Farmacotherapy (SWEFOT) clinical trial. RP was defined as an increase in the Van der Heijde-modified Sharp score by more than five points over 1 year. Associations between baseline disease activity measures, the MBDA score, and 1-year RP were evaluated using univariate and multivariate logistic regression, adjusted for potential confounders.

Results Among 235 patients with eRA, 5 had low and 29 moderate MBDA scores at baseline. None of the former and only one of the latter group (3.4%) had RP during 1 year, while the proportion of patients with RP among those with high MBDA score was 20.9% (p=0.021). Among patients with low/moderate CRP, moderate DAS28-CRP or moderate DAS28-ESR at baseline, progression occurred in 14%, 15%, 14% and 15%, respectively. MBDA score was an independent predictor of RP as a continuous (OR=1.05, 95% CI 1.02 to 1.08) and dichotomised variable (high versus low/moderate, OR=3.86, 95% CI 1.04 to 14.26).

Conclusions In patients with eRA, the MBDA score at baseline was a strong independent predictor of 1-year RP. These results suggest that when choosing initial treatment in eRA the MBDA test may be clinically useful to identify a subgroup of patients at low risk of RP.

Trial registration number WHO database at the Karolinska Institute: CT20080004; and clinicaltrials.gov: NCT00764725.

  • Rheumatoid Arthritis
  • Disease Activity
  • Anti-TNF
  • Cytokines
  • Patient perspective

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/annrheumdis-2013-204986

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