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Curr Med Res Opin. 2019 Sep;35(9):1483-1493. doi: 10.1080/03007995.2019.1585064. Epub 2019 Mar 14.

Predicting risk for radiographic damage in rheumatoid arthritis: comparative analysis of the multi-biomarker disease activity score and conventional measures of disease activity in multiple studies.

Author information

1
University of Alabama at Birmingham, Birmingham, AL, USA.
2
Copenhagen Center for Arthritis Research and DANBIO, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.
3
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
4
Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
5
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
6
Crescendo Bioscience Inc., South San Francisco, CA, USA.
7
Myriad Genetics Inc., Salt Lake City, UT, USA.
8
Leiden University Medical Center, Leiden, Netherlands.

Abstract

Objective: To compare the multi-biomarker disease activity (MBDA) score with the DAS28-CRP and CRP for predicting risk of radiographic progression in patients with rheumatoid arthritis.Methods: Published studies of the MBDA score and radiographic progression with ≥100 patients per cohort were evaluated. Rates of radiographic progression over 1 year were determined across the low/moderate/high categories for MBDA score (low/moderate/high: <30, 30-44, >44), DAS28-CRP (low/moderate/high: ≤2.67, >2.67-4.09, >4.09) and CRP (low/moderate/high: ≤10, >10-30, >30 mg/L), with positive and negative predictive value (PPV, NPV) and relative risk (RR) determined for high vs. not-high (i.e. low and moderate combined) categories. Patient-level data from studies having all three measures was pooled to: (1) determine a combined RR for radiographic progression in the high vs. not-high categories for each measure; and (2) compare the predictive ability of MBDA score vs. DAS28-CRP by comparing the rates of radiographic progression observed in subgroups created by cross-classifying the high and not-high categories of each measure.Results: Five cohorts were identified for inclusion (total N=929). In each, radiographic progression was more frequent with increasing MBDA scores. Among the three cohorts with requisite data, PPVs were generally similar using categories of MBDA score, DAS28-CRP or CRP but NPVs were greater for MBDA score (93-97%) than DAS28-CRP or CRP (77-87%). RRs for radiographic progression were greater when based on categories of MBDA score than DAS28-CRP or CRP and the combined RR was greater for MBDA score (4.6, p < .0001) than DAS28-CRP (1.7, p = .02) or CRP (1.7, p = .002). For patients cross-classified by MBDA score and DAS28-CRP, high vs. not-high MBDA score significantly predicted radiographic progression independently of DAS28-CRP.Conclusions: High and not-high MBDA scores were associated with increased and low risk, respectively, for radiographic progression over one year. MBDA score was a better predictor of radiographic progression than DAS28-CRP or CRP.

KEYWORDS:

Disease activity; multi-biomarker; radiographic progression; rheumatoid arthritis; risk prediction

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