Prediction of sustained biologic and targeted synthetic DMARD-free remission in rheumatoid arthritis patients.

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_7E3A79CD32A0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prediction of sustained biologic and targeted synthetic DMARD-free remission in rheumatoid arthritis patients.
Journal
Rheumatology advances in practice
Author(s)
Burkard T., Williams R.D., Vallejo-Yagüe E., Hügle T., Finckh A., Kyburz D., Burden A.M.
ISSN
2514-1775 (Electronic)
ISSN-L
2514-1775
Publication state
Published
Issued date
2021
Peer-reviewed
Oui
Volume
5
Number
3
Pages
rkab087
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
The aim was to develop a prediction model of sustained remission after cessation of biologic or targeted synthetic DMARD (b/tsDMARD) in RA.
We conducted an explorative cohort study among b/tsDMARD RA treatment episode courses stopped owing to remission in the Swiss Clinical Quality Management registry (SCQM; 2008-2019). The outcome was sustained b/tsDMARD-free remission of ≥12 months. We applied logistic regression model selection algorithms using stepwise, forward selection, backward selection and penalized regression to identify patient characteristics predictive of sustained b/tsDMARD-free remission. We compared c-statistics corrected for optimism between models. The three models with the highest c-statistics were validated in new SCQM data until 2020 (validation dataset).
We identified 302 eligible episodes, of which 177 episodes (59%) achieved sustained b/tsDMARD-free remission. Two backward and one forward selection model, with eight, four and seven variables, respectively, obtained the highest c-statistics corrected for optimism of c = 0.72, c = 0.70 and c = 0.69, respectively. In the validation dataset (47 eligible episodes), the models performed with c = 0.99, c = 0.80 and c = 0.74, respectively, and excellent calibration. The best model included the following eight variables (measured at b/tsDMARD stop): RA duration, b/tsDMARD duration, other pain/anti-inflammatory drug use, quality of life (EuroQol), DAS28-ESR score, HAQ score, education, and interactions of RA duration and other pain/anti-inflammatory drug use and of b/tsDMARD duration and HAQ score.
Our results suggest that models with up to eight unique variables may predict sustained b/tsDMARD-free remission with good efficiency. External validation is warranted.
Keywords
Swiss Clinical Quality Management, biologic DMARD, biologics, remission, rheumatoid arthritis, targeted synthetic DMARD, treatment discontinuation
Pubmed
Web of science
Open Access
Yes
Create date
20/12/2021 14:30
Last modification date
09/08/2024 16:01
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