Predictive value of a multi-biomarker disease activity score for clinical remission and radiographic progression in patients with early rheumatoid arthritis: a post-hoc study of the OPERA trial

  • I. Hansen (Contributor)
  • C H Brahe (Contributor)
  • M. L. Hetland (Contributor)
  • J. Raun (Contributor)
  • T. Lottenburger (Contributor)
  • K. Hørslev-Petersen (Contributor)
  • A. Jørgensen (Contributor)
  • K. Stengaard-Pedersen (Contributor)
  • M. Østergaard (Contributor)
  • S.B. Krintel (Contributor)
  • J.S. Johansen (University of Copenhagen) (Contributor)
  • X Wang (Contributor)
  • H. Lindegaard (University of Southern Denmark) (Contributor)
  • M Y Dam (Contributor)
  • C. Ammitzbøll (Contributor)
  • Annette M Mortensen Schlemmer (Contributor)
  • R Bolce (Contributor)
  • P. Junker (Contributor)
  • E H Sasso (Contributor)
  • L.M. Ørnbjerg (Contributor)
  • P. Ahlquist (Contributor)
  • T. Ellingsen (Contributor)
  • Asta Linauskas (Contributor)
  • N Defranoux (Contributor)



<b>Objectives</b>: Measurement of serum biomarkers at disease onset may improve prediction of disease course in patients with early rheumatoid arthritis (RA). We evaluated the multi-biomarker disease activity (MBDA) score and early changes in MBDA score for prediction of 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP) remission and radiographic progression in the double-blinded OPERA trial. <b>Method</b>: Treatment-naïve RA patients (N = 180) with moderate or high DAS28 were randomized to methotrexate (MTX) + adalimumab (n = 89) or MTX + placebo (n = 91) in combination with glucocorticoid injection into swollen joints. X-rays of hands and feet were evaluated at months 0 and 12 (n = 164) by the total Sharp van der Heijde score (TSS). The smallest detectable change (1.8 TSS units) defined radiographic progression (∆TSS ≥ 2). Clinical remission (DAS28-CRP <b>Results</b>: Baseline MBDA score was independently associated with radiographic progression at 1 year [odds ratio (OR) = 1.03/unit, 95% confidence interval (CI) = 1.01–1.06], and changes in MBDA score from baseline to 3 months with clinical remission at 6 months [OR = 0.98/unit, 95% CI 0.96–1.00). In anti-cyclic citrullinated peptide antibody (anti-CCP)-positive patients, 35 of 89 with high MBDA score (&gt; 44) showed radiographic progression (PPV = 39%), compared with 0 of 15 patients (NPV = 100%) with low/moderate MBDA score (≤ 44) (p = 0.003). <b>Conclusion</b>: Early changes in MBDA score were associated with clinical remission based on DAS28-CRP at 6 months. In anti-CCP-positive patients, a non-high baseline MBDA score (≤ 44) had a clinical value by predicting very low risk of radiographic progression at 12 months.
Date made available1 Jan 2018
PublisherTaylor & Francis

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