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Investigating the validity of the minimal disease activity state for patients with rheumatoid arthritis treated with
George A Wells1, Maarten Boers, Tracy Li
1Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario KIH 8M5, Canada. gawells@ottawaheart.ca
Objective:
To validate the definitions of minimal disease activity (MDA) in patients with rheumatoid arthritis (RA) and to compare abatacept to control with respect to patients attaining a state of MDA.
Methods:
Two randomized controlled trials comparing abatacept to control in patients with RA were considered: ATTAIN and AIM. Core set measures, Disease Activity Score 28-joint count (DAS28), and, for AIM, radiographic scores were available. The core set and DAS-based definitions for MDA were calculated and the number of patients in the treatment groups meeting the definitions was compared to determine sensitivity of the criteria to treatment differences and patient severity. The number of times achieving MDA was compared to the change in Health Assessment Questionnaire (HAQ), and for the AIM study compared to change in radiographic scores.
Results:
For both definitions of MDA, the change in radiographic scores showed a continual decrease in progression the more often a patient was in MDA. The change in HAQ, for both studies, showed a similar consistent improvement - the longer a patient was in MDA, then the better the HAQ score. Significantly more patients in the abatacept group met the core set and DAS-based definition of MDA than in the control group.
Conclusion:
The presence and persistence of MDA was associated with slowing of radiographic progression and improvement in the HAQ, providing support for discriminative and predictive validity of the measure. The MDA results were consistent with other efficacy analyses indicating a treatment advantage for abatacept.
Insights
Achieving minimal disease activity (MDA) in rheumatoid arthritis (RA) slows radiographic progression and improves function. More patients on abatacept reached MDA compared to controls.
Area of Science:
- Rheumatology
- Clinical Trials
- Disease Activity Measurement
Background:
- Rheumatoid arthritis (RA) management aims to achieve remission or minimal disease activity (MDA).
- Validating definitions of MDA is crucial for assessing treatment efficacy in RA.
- Abatacept is a biologic therapy used for RA treatment.
Purpose of the Study:
- To validate definitions of minimal disease activity (MDA) in rheumatoid arthritis (RA) patients.
- To compare the efficacy of abatacept versus control in achieving MDA.
- To assess the association between MDA and clinical outcomes like radiographic progression and functional status.
Main Methods:
- Analysis of two randomized controlled trials (ATTAIN and AIM) in RA patients treated with abatacept or control.
- Calculation of core set and Disease Activity Score 28-joint count (DAS28)-based definitions for MDA.
- Comparison of MDA achievement rates between treatment groups and correlation with changes in Health Assessment Questionnaire (HAQ) and radiographic scores.
Main Results:
- Persistent presence in MDA correlated with decreased radiographic progression and improved HAQ scores.
- Significantly more patients in the abatacept group achieved MDA compared to the control group.
- MDA definitions demonstrated sensitivity to treatment differences and patient severity.
Conclusions:
- The presence and persistence of MDA are associated with better radiographic and functional outcomes in RA.
- These findings support the discriminative and predictive validity of MDA measures.
- Results indicate a treatment advantage for abatacept in achieving MDA and improving patient outcomes.
