Association of a multibiomarker disease activity score at multiple time-points with radiographic progression in rheumatoid arthritis: results from the SWEFOT trial

Abstract

ObjectivesIn rheumatoid arthritis (RA), predictive biomarkers for subsequent radiographic progression (RP) could improve therapeutic choices for individual patients. We previously showed that the multibiomarker disease activity (MBDA) score in patients with newly diagnosed RA identified patients at risk for RP. We evaluated the MBDA score at multiple time-points as a predictor of RP during 2 years of follow-up.MethodsA subset of patients with RA (N=220) from the Swedish Farmacotherapy (SWEFOT) trial were analysed for MBDA score, disease activity score of 28 joints (DAS28), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at baseline (BL), month 3 and year 1, for predicting RP based on modified Sharp/van der Heijde scores at BL, year 1 and year 2.ResultsPatients with persistently low MBDA (<30) scores or those with a decrease from moderate (30–44) to low MBDA scores, did not develop RP during 2 years of follow-up. The highest risk for RP during 2 years of follow-up (42%) was observed among patients with persistently high (>44) MBDA scores. Among methotrexate non-responders with a high MBDA score at BL or month 3, significantly more of those who received triple therapy had RP at year 2 compared with those who received antitumour necrosis factor therapy.ConclusionsMeasuring the MBDA score both before and during treatment in RA was useful for the assessment of individual patient risk for RP during 2 years of follow-up. In comparison with low CRP, ESR or DAS28, a low MBDA score at any time-point was associated with numerically lower proportions of RP.Trial registration numberNCT00764725.

Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis

“…79 The correlation of the MBDA score with radiographic progression was weak (OR per unit of increase: close to 1.0 (1.0 to 1.1)). The association of higher (>44) MBDA scores and radiographic progression was better (OR vs low score 3.9 (1.0 to 14.3)), but, while the NPV for this cut-off was high (97%), the PPV did not exceed 20%; and thus MBDA scores appear to be of minor value for clinical practice.…”

A Multi‐Biomarker Disease Activity Score and the Choice of Second‐Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure

“…We previously showed in the SWEFOT trial that MTX‐IR patients receiving anti‐TNF therapy had a significantly lower proportion of radiographic progression at year 2 compared with those receiving triple therapy 18. However, in a later study of the same patients, it was shown that patients with low MBDA scores at the time of randomization did not progress radiographically during 2 years from baseline, regardless of the choice of therapy 28. Neither differed in the proportion of patients with 2‐year radiographic progression among those with moderate MBDA scores between the anti‐TNF and triple therapy groups (24% and 25%, respectively).…”

Proteomics to predict the response to tumour necrosis factor-α inhibitors in rheumatoid arthritis using a supervised cluster-analysis based protein score

“…As for the prediction of response, the abilities of the MBDA test have yet to be investigated. However, it has been shown that the baseline MBDA score is a significant prognostic factor for radiographic progression, according to one study (26), but is not able to predict radiographic progression over time better than DAS28, according to another study (23). In addition, one study found hardly any correlation between the MBDA score and several disease activity measurements in RA patients treated with biologicals (27).…”