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VBCR - December 2015, Volume 4, No 6 - Personalized Medicine in Rheumatology
Rosemary Frei, MSc

Clinicians may be able to use the multibiomarker disease activity (MBDA) score to predict rheumatoid arthritis (RA) flares within a year of discontinuation of tumor necrosis factor inhibitor (TNFi).

A poster presented at the 2015 annual meeting of the American College of Rheumatology revealed an approximately 2-fold increase in probability of a flare in people with baseline MBDA scores that were high (>44) versus moderate (30-44) or low (<30). This held true whether the definition of a flare was TNFi restart, medication escalation, or clinician-reported flare.

Sixteen Dutch researchers analyzed data from the 439-patient, Crescendo Bioscience–funded Potential Optimalisation Expediency of TNF-Inhibitor (POET) study. The patients had low disease activity (LDA) and were randomized to stop or continue TNFi. Univariate analyses showed that disease duration, body mass index (BMI), Disease Activity Score (DAS) 28–erythrocyte sedimentation rate (ESR), and MBDA score were all significantly different between patients with and without a flare after TNFi cessation.

The odds ratios of a flare among people with a high MBDA score at baseline versus a moderate or low score were 1.85 based on a flare definition of TNFi restart, 1.99 with medication escalation as the definition, and 2.00 based on clinician-reported flare.

In conclusion, longer disease duration, higher BMI, DAS28-ESR, and MBDA score assessed at TNFi cessation were associated with RA disease flare. Also, in RA patients with LDA, a high MBDA score independently predicted flare within 1 year after TNFi discontinuation.­

Reference

Lamers-Karnebeek F, Moghadam G, Vonkeman HE, et al. Multi-biomarker disease activity score as a predictor of flare in rheumatoid arthritis patients who stop TNF-inhibitor in the POET-study. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 2594.

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