Remission nowadays is the guiding target of management of - - PowerPoint PPT Presentation

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Feb 19, 2024 13 likes •54 views

Remission nowadays is the guiding target of management of rheumatoid arthritis (RA). However, no gold standard definition of remission exists and the inclusion of patient global assessment (PGA) in remission definitions is debated.

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Revisiting the remission criteria for rheumatoid arthritis by excluding patient global assessment:

An individual patient meta-analysis including 5792 patients

Ricardo J.O. Ferreira1,2, Paco M. J. Welsing3, Johannes W.G. Jacobs3, Laure Gossec4,5, Mwidimi Ndosi6, Pedro M. Machado7, Désirée van der Heijde8, José A.P. da Silva1,9

1 – Rheumatology – CHUC, Coimbra, Portugal; 2 – ESEnfc, UICISA:E, Coimbra, Portugal; 3 – UMC Utrecht, Rheumatology & Clinical Immunology, Netherlands; 4 – Sorbonne Université, INSERM, Paris, France; 5 – Rheumatology, Pitié Salpêtrière hospital, Paris, France; 6 – UWE Bristol, Nursing and Midwifery, Bristol, UK; 7 – Centre for Rheumatology & Neuromuscular Diseases, London, UK; 8 – LUMC, Rheumatology, Leiden, Netherlands; 9 – Faculty of Medicine, University of Coimbra, Coimbra Portugal Source of the image: creakyjoints.org

Remission nowadays is the guiding target of management

f rheumatoid arthritis (RA).

However, no gold standard definition of remission exists and the inclusion of patient global assessment (PGA) in remission definitions is debated.

SLIDE 2

Aim:

To determine the impact of excluding patient global assessment (PGA) from the ACR/EULAR Boolean remission criteria, upon prediction of radiographic outcome of RA. Methods:

Meta-analyses using individual patient data from RCTs, testing the efficacy of biological agents on radiographic outcomes at ≥2 years. § Predictor: Remission, using the ACR/EULAR remission criteria at 6 OR 12 months:

4V-remission
PGA-near-remission
No remission
3V-remission (= 4V + 4V-near)

§ Outcome: Good Radiographic Outcome (GRO) defined as a change of ≤ 0.5 modified Total Sharp Score (mTSS) units, from 12 to 24m. § Analyses: The pooled probabilities of GRO and accuracy for the different definitions of remission were estimated and compared. Meta-analyses were performed using the DerSimonian-Laird random-effects method.

Source: Ferreira RJO, et al. Ann Rheum Dis 2020;0:1–11. doi:10.1136/annrheumdis-2020-217171

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i) Sample

TP= True Positive TN = True Negative

Results

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rferreira@reumahuc.org jdasilva@ci.uc.pt t: @FerreiraRJO

Conclusions:

PGA-near-remission and Boolean 4V-remission are similarly predictive of Good Radiographic

Outcome (GRO) in RA

3V-remission (excluding PGA) showed a statistically better predictive accuracy of GRO than 4V-

remission

3V-remission potentially reduces the risk of overtreatment compared to the 4V-definition
The patient's perspective, which must remain central,

requires a separate treatment aim: a dual-target approach.

Ferreira RJO, Welsing PMJ, Jacobs JWG et al. Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients. Ann Rheum Dis 2020;0:1–11. doi:10.1136/annrheumdis-2020-217171