Integrated longitudinal analysis does not compromise precision and reduces bias in the study of imaging outcomes: A comparative 5-year analysis in the DESIR cohort

Seminars in Arthritis and Rheumatism, vol. 50, pp. 1394–1399

Abstract

OBJECTIVE: To assess if an integrated longitudinal analysis using all available imaging data affects the precision of estimates of change in patients with axial spondyloarthritis (axSpA), with completers analysis as reference standard. METHODS: Patients from the DESIR cohort fulfilling the ASAS axSpA criteria were included. Radiographs and MRIs of the sacroiliac joints and spine were obtained at baseline, 1, 2 and 5 years. Each image was scored by 2 or 3 readers in 3 'reading-waves' (or campaigns). Each outcome was analyzed: i. According to a 'combination algorithm' (e.g. '2 out of 3' for binary scores); and ii. Per reader. Change over time was analyzed with generalized estimating equations by 3 approaches: (a)'integrated-analysis' (all patients with ≥1 score from ≥1 reader from all waves); (b1)Completers-only analysis (patients with 5-year follow-up, using scores from individual readers); (b2)Completers analysis using a 'combination algorithm' (as (b1) but with combined scores). Approaches (b1) and (b2) were considered the 'reference'. RESULTS: In total, 413 patients were included. The 'integrated analysis' was more inclusive with similar levels of precision of the change estimates as compared to both completers analyses. In fact, for low-incident outcomes (e.g.% mNY-positive over 5-years), an increased incidence was 'captured', with more precision, by the 'integrated analysis' compared to the completers analysis with combined scores (% change/year (95%CI): 1.1 (0.7; 1.5) vs 1.2 (0.5; 1.8), respectively). CONCLUSION: An efficient and entirely assumption-free 'integrated analysis' does not jeopardize precision of the estimates of change in imaging parameters and may yield increased statistical power for detecting changes with low incidence.

Authors 9

1. Alexandre Rocha Sepriano corresponding Aachen

   Leiden University Medical Center · Universidade Nova de Lisboa

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: alexsepriano@gmail.com

   Leiden University Medical Center

   Universidade Nova de Lisboa = NOVA University Lisbon

2. Sofía Ramiro Aachen

   Zuyd University of Applied Sciences · Leiden University Medical Center · Zuyderland Medisch Centrum

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Zuyderland Medical Center, Heerlen, the Netherlands

   Leiden University Medical Center

   Zuyd University of Applied Sciences (Heerlen, Pays-Bas)

3. Désirée M F M van der Heijde Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: mail@dvanderheijde.nl

   Leiden University Medical Center

4. Maxime Dougados

   Inserm · Université Paris Cité · Sorbonne Paris Cité · Hôpital Cochin · Assistance Publique – Hôpitaux de Paris · Centre de Recherche Épidémiologie et Statistique · Université Paris Descartes

   Affiliation as printed

   Paris Descartes University, France; Department of Rheumatology, Clinical epidemiology and biostatistics, Hôpital Cochin. Assistance Publique - Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité. PARIS 14, France. Electronic address: maxime.dougados@aphp.fr

   Hôpital Cochin [AP-HP]

   UFR Sciences Fondamentales et Biomédicales [Sciences] - Université Paris Cité

5. Pascal Claudepierre

   Centre Hospitalier Universitaire Henri-Mondor · Assistance Publique – Hôpitaux de Paris · Hôpitaux Universitaires Henri-Mondor

   Affiliation as printed

   Department of Rheumatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris Créteil, France. Electronic address: pascal.claudepierre@aphp.fr

   Hôpital Henri Mondor

6. A. Feydy Aachen

   Leiden University Medical Center · Hôpital Cochin · Université Paris Descartes

   Affiliation as printed

   Radiology B Department, Cochin Hôpital Paris Descartes University Paris, France. Electronic address: antoine.feydy@aphp.fr

   Leiden University Medical Center

7. M. Reijnierse Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: m.reijnierse@lumc.nl

   Leiden University Medical Center

8. Damien Lœuille

   Centre Hospitalier Régional et Universitaire de Nancy · Ingénierie Moléculaire, Cellulaire et Physiopathologie

   Affiliation as printed

   Department of Rheumatology, Hôpital Brabois, Nancy, France. Electronic address: d.loeuille@chru-nancy.fr

   Ingénierie Moléculaire et Physiopathologie Articulaire

   Service de Rhumatologie [CHRU Nancy]

9. Robert Landewé

   Zuyderland Medisch Centrum · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Zuyderland Medical Center, Heerlen, the Netherlands; Amsterdam University Medical Center (ARC), Amsterdam, the Netherlands. Electronic address: landewe@rlandewe.nl

   University of Amsterdam [Amsterdam] = Universiteit van Amsterdam