Hand-dominant joint involvement pattern associates with favourable, and polyarthritis with unfavourable, treatment response to both csDMARDs and bDMARDs in early rheumatoid arthritis: a combined analysis of NORD-STAR and BeSt trials
Annals of the Rheumatic Diseases, vol. 85, pp. 1218–1228
Abstract
OBJECTIVES: To investigate the association between joint involvement pattern (JIP) subgroups and treatment responses to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biological disease-modifying antirheumatic drugs (bDMARDs), and to compare the impact of JIP subgroups with other clinical parameters in treatment-naïve patients with early rheumatoid arthritis (RA). METHODS: An individual patient data meta-analysis was conducted using 2 randomised controlled trials, NOrdic Rheumatic Diseases Strategy Trials And Registries (NORD-STAR) and Behandel-Strategieën (BeSt), including 1250 treatment-naïve patients with early RA. JIP subgroup assignment was based on 4 previously identified subgroups defined by baseline clinical characteristics, primarily joint involvement in the 66/68 joint scheme. Treatment outcomes were measured using the longitudinal Clinical Disease Activity Index (CDAI) and other disease activity indices through week 48. Associations of the JIP subgroups and other clinical predictors were evaluated using a mixed-model analysis. RESULTS: Patients with a hand-dominant JIP (JIP-Hand) showed significantly better CDAI scores after treatment (Beta for CDAI = -1.4 [95% CI, -2.3 to -0.55]; p = .0016), whereas those with a polyarthritis pattern (JIP-Poly) exhibited worse outcomes (Beta = 0.95 [95% CI, 0.064-1.8]; p = .035). Female sex was also associated with worse CDAI scores (Beta = 1.2 [95% CI, 0.40-2.0]; p = .0031), whereas anticitrullinated protein antibodies did not show a significant association (Beta = 0.19 [95% CI, -0.69 to 1.1]; p = .67). When compared across groups, csDMARDs and combined bDMARDs were similarly effective in the respective JIP subgroups (interaction p > .10). CONCLUSIONS: In early RA, csDMARD and bDMARD treatments resulted in the greatest improvement in disease activity in JIP-Hand and the least improvement in JIP-Poly.
Authors 21
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Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: y.nagafuchi@lumc.nl
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Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Karolinska Institutet · Amsterdam University Medical Centers
Affiliation as printed
Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands; Division of Rheumatology, Department of Medicine, Center for Molecular Medicine (CMM), Karolinska Institute, Stockholm, Sweden
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Sahlgrenska University Hospital
Affiliation as printed
Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
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University of Iceland · National University Hospital of Iceland
Affiliation as printed
Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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University of Helsinki · Helsinki University Hospital
Affiliation as printed
Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
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Affiliation as printed
Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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University of Iceland · National University Hospital of Iceland
Affiliation as printed
Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Division of Rheumatology, Department of Medicine, Center for Molecular Medicine (CMM), Karolinska Institute, Stockholm, Sweden; Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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University of Southern Denmark
Affiliation as printed
Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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Affiliation as printed
Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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University of Copenhagen · Rigshospitalet
Affiliation as printed
Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
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Reade · Amsterdam University Medical Centers
Affiliation as printed
Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, Reade Amsterdam, Noord-Holland, The Netherlands
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University of Copenhagen · Rigshospitalet
Affiliation as printed
Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
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Semmelweis University · Amsterdam University Medical Centers
Affiliation as printed
Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Rheumatology, Semmelweis University, Budapest, Hungary
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University of Oslo · Diakonhjemmet Hospital
Affiliation as printed
Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
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Affiliation as printed
Department of Medicine and University of Eastern Finland, Jyväskylä Central Hospital, Jyväskylä, Finland
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Erik B. van den Akker Aachen
Leiden University Medical Center · Delft University of Technology
Affiliation as printed
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Rachel Knevel Aachen
Leiden University Medical Center · Newcastle University · Delft University of Technology
Affiliation as printed
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, The Netherlands; Newcastle University School of Clinical Medical Sciences, Newcastle upon Tyne, UK
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