Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-α blockers: The GISEA study

Luana Mancarella, Francesca Bobbio-Pallavicini, Fulvia Ceccarelli, Paola Chiara Falappone, Angelo Ferrante, Domenico Malesci, Alfonso Massara, Francesca Nacci, Maria Elena Secchi, Stefania Manganelli, Fausto Salaffi, Maria Lisa Bambara, Stefano Bombardieri, Maurizio Cutolo, Clodoveo Ferri, Mauro Galeazzi, Roberto Gerli, Roberto Giacomelli, Walter Grassi, Giovanni LapadulaMarco Matucci Cerinic, Carlomaurizio Montecucco, Francesco Trotta, Giovanni Triolo, Gabriele Valentini, Guido Valesini, Gianfranco F. Ferraccioli

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Objective. To assess the prevalence of good clinical response and remission in rheumatoid arthritis (RA) patients with longstanding disease treated with anti-tumor necrosis factor-α (TNF-α) drugs at outpatient clinics. Methods. Retrospective national study of 14 academic tertiary referral rheumatology medical centers. RA patients with a Disease Activity Score (DAS28) > 3.2 were defined as having active disease and could start TNF-α blockers. All patients received one TNF-α blocker plus methotrexate (10-20 mg/wk). At the third month the patients were categorized as responders or nonresponders, based on improvement of at least 0.25 of the Health Assessment Questionnaire (HAQ). Those who had improved by at least 0.25 HAQ were analyzed for possible predictors of DAS28 remission at the sixth month. Results. A total of 1257 patients started TNF-α blockers. Of these, 591 (46.7%) reached the sixth month with an improvement of HAQ of 0.25 at the third month. In the cohort of patients reaching HAQ of 0.25, DAS28 remission was seen in 24% of rheumatoid factor (RF)-positive and 36% of RF-negative patients (p = 0.03). Logistic regression analysis for predictors of remission identified age at baseline, HAQ <1.63, and RF negativity as positive predictors of remission at 6 months along with sex (male). Conclusion. We show that only a minority of patients with longstanding RA achieve a good clinical response or remission at the outpatient community level. Predictors of remission identify characteristics commonly observed in subsets with less severe RA.

Original languageEnglish
Pages (from-to)1670-1673
Number of pages4
JournalJournal of Rheumatology
Volume34
Issue number8
Publication statusPublished - Aug 2007

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Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Rheumatoid Factor
Health
Rheumatology
Ambulatory Care Facilities
Methotrexate
Outpatients
Referral and Consultation
Retrospective Studies
Logistic Models
Regression Analysis
Surveys and Questionnaires
Pharmaceutical Preparations

Keywords

  • Disability score
  • Good clinical response
  • Remission
  • Rheumatoid arthritis
  • Tumor necrosis factor-α blockers

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-α blockers : The GISEA study. / Mancarella, Luana; Bobbio-Pallavicini, Francesca; Ceccarelli, Fulvia; Falappone, Paola Chiara; Ferrante, Angelo; Malesci, Domenico; Massara, Alfonso; Nacci, Francesca; Secchi, Maria Elena; Manganelli, Stefania; Salaffi, Fausto; Bambara, Maria Lisa; Bombardieri, Stefano; Cutolo, Maurizio; Ferri, Clodoveo; Galeazzi, Mauro; Gerli, Roberto; Giacomelli, Roberto; Grassi, Walter; Lapadula, Giovanni; Cerinic, Marco Matucci; Montecucco, Carlomaurizio; Trotta, Francesco; Triolo, Giovanni; Valentini, Gabriele; Valesini, Guido; Ferraccioli, Gianfranco F.

In: Journal of Rheumatology, Vol. 34, No. 8, 08.2007, p. 1670-1673.

Research output: Contribution to journalArticle

Mancarella, L, Bobbio-Pallavicini, F, Ceccarelli, F, Falappone, PC, Ferrante, A, Malesci, D, Massara, A, Nacci, F, Secchi, ME, Manganelli, S, Salaffi, F, Bambara, ML, Bombardieri, S, Cutolo, M, Ferri, C, Galeazzi, M, Gerli, R, Giacomelli, R, Grassi, W, Lapadula, G, Cerinic, MM, Montecucco, C, Trotta, F, Triolo, G, Valentini, G, Valesini, G & Ferraccioli, GF 2007, 'Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-α blockers: The GISEA study', Journal of Rheumatology, vol. 34, no. 8, pp. 1670-1673.
Mancarella, Luana ; Bobbio-Pallavicini, Francesca ; Ceccarelli, Fulvia ; Falappone, Paola Chiara ; Ferrante, Angelo ; Malesci, Domenico ; Massara, Alfonso ; Nacci, Francesca ; Secchi, Maria Elena ; Manganelli, Stefania ; Salaffi, Fausto ; Bambara, Maria Lisa ; Bombardieri, Stefano ; Cutolo, Maurizio ; Ferri, Clodoveo ; Galeazzi, Mauro ; Gerli, Roberto ; Giacomelli, Roberto ; Grassi, Walter ; Lapadula, Giovanni ; Cerinic, Marco Matucci ; Montecucco, Carlomaurizio ; Trotta, Francesco ; Triolo, Giovanni ; Valentini, Gabriele ; Valesini, Guido ; Ferraccioli, Gianfranco F. / Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-α blockers : The GISEA study. In: Journal of Rheumatology. 2007 ; Vol. 34, No. 8. pp. 1670-1673.
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abstract = "Objective. To assess the prevalence of good clinical response and remission in rheumatoid arthritis (RA) patients with longstanding disease treated with anti-tumor necrosis factor-α (TNF-α) drugs at outpatient clinics. Methods. Retrospective national study of 14 academic tertiary referral rheumatology medical centers. RA patients with a Disease Activity Score (DAS28) > 3.2 were defined as having active disease and could start TNF-α blockers. All patients received one TNF-α blocker plus methotrexate (10-20 mg/wk). At the third month the patients were categorized as responders or nonresponders, based on improvement of at least 0.25 of the Health Assessment Questionnaire (HAQ). Those who had improved by at least 0.25 HAQ were analyzed for possible predictors of DAS28 remission at the sixth month. Results. A total of 1257 patients started TNF-α blockers. Of these, 591 (46.7{\%}) reached the sixth month with an improvement of HAQ of 0.25 at the third month. In the cohort of patients reaching HAQ of 0.25, DAS28 remission was seen in 24{\%} of rheumatoid factor (RF)-positive and 36{\%} of RF-negative patients (p = 0.03). Logistic regression analysis for predictors of remission identified age at baseline, HAQ <1.63, and RF negativity as positive predictors of remission at 6 months along with sex (male). Conclusion. We show that only a minority of patients with longstanding RA achieve a good clinical response or remission at the outpatient community level. Predictors of remission identify characteristics commonly observed in subsets with less severe RA.",
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author = "Luana Mancarella and Francesca Bobbio-Pallavicini and Fulvia Ceccarelli and Falappone, {Paola Chiara} and Angelo Ferrante and Domenico Malesci and Alfonso Massara and Francesca Nacci and Secchi, {Maria Elena} and Stefania Manganelli and Fausto Salaffi and Bambara, {Maria Lisa} and Stefano Bombardieri and Maurizio Cutolo and Clodoveo Ferri and Mauro Galeazzi and Roberto Gerli and Roberto Giacomelli and Walter Grassi and Giovanni Lapadula and Cerinic, {Marco Matucci} and Carlomaurizio Montecucco and Francesco Trotta and Giovanni Triolo and Gabriele Valentini and Guido Valesini and Ferraccioli, {Gianfranco F.}",
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TY - JOUR

T1 - Good clinical response, remission, and predictors of remission in rheumatoid arthritis patients treated with tumor necrosis factor-α blockers

T2 - The GISEA study

AU - Mancarella, Luana

AU - Bobbio-Pallavicini, Francesca

AU - Ceccarelli, Fulvia

AU - Falappone, Paola Chiara

AU - Ferrante, Angelo

AU - Malesci, Domenico

AU - Massara, Alfonso

AU - Nacci, Francesca

AU - Secchi, Maria Elena

AU - Manganelli, Stefania

AU - Salaffi, Fausto

AU - Bambara, Maria Lisa

AU - Bombardieri, Stefano

AU - Cutolo, Maurizio

AU - Ferri, Clodoveo

AU - Galeazzi, Mauro

AU - Gerli, Roberto

AU - Giacomelli, Roberto

AU - Grassi, Walter

AU - Lapadula, Giovanni

AU - Cerinic, Marco Matucci

AU - Montecucco, Carlomaurizio

AU - Trotta, Francesco

AU - Triolo, Giovanni

AU - Valentini, Gabriele

AU - Valesini, Guido

AU - Ferraccioli, Gianfranco F.

PY - 2007/8

Y1 - 2007/8

N2 - Objective. To assess the prevalence of good clinical response and remission in rheumatoid arthritis (RA) patients with longstanding disease treated with anti-tumor necrosis factor-α (TNF-α) drugs at outpatient clinics. Methods. Retrospective national study of 14 academic tertiary referral rheumatology medical centers. RA patients with a Disease Activity Score (DAS28) > 3.2 were defined as having active disease and could start TNF-α blockers. All patients received one TNF-α blocker plus methotrexate (10-20 mg/wk). At the third month the patients were categorized as responders or nonresponders, based on improvement of at least 0.25 of the Health Assessment Questionnaire (HAQ). Those who had improved by at least 0.25 HAQ were analyzed for possible predictors of DAS28 remission at the sixth month. Results. A total of 1257 patients started TNF-α blockers. Of these, 591 (46.7%) reached the sixth month with an improvement of HAQ of 0.25 at the third month. In the cohort of patients reaching HAQ of 0.25, DAS28 remission was seen in 24% of rheumatoid factor (RF)-positive and 36% of RF-negative patients (p = 0.03). Logistic regression analysis for predictors of remission identified age at baseline, HAQ <1.63, and RF negativity as positive predictors of remission at 6 months along with sex (male). Conclusion. We show that only a minority of patients with longstanding RA achieve a good clinical response or remission at the outpatient community level. Predictors of remission identify characteristics commonly observed in subsets with less severe RA.

AB - Objective. To assess the prevalence of good clinical response and remission in rheumatoid arthritis (RA) patients with longstanding disease treated with anti-tumor necrosis factor-α (TNF-α) drugs at outpatient clinics. Methods. Retrospective national study of 14 academic tertiary referral rheumatology medical centers. RA patients with a Disease Activity Score (DAS28) > 3.2 were defined as having active disease and could start TNF-α blockers. All patients received one TNF-α blocker plus methotrexate (10-20 mg/wk). At the third month the patients were categorized as responders or nonresponders, based on improvement of at least 0.25 of the Health Assessment Questionnaire (HAQ). Those who had improved by at least 0.25 HAQ were analyzed for possible predictors of DAS28 remission at the sixth month. Results. A total of 1257 patients started TNF-α blockers. Of these, 591 (46.7%) reached the sixth month with an improvement of HAQ of 0.25 at the third month. In the cohort of patients reaching HAQ of 0.25, DAS28 remission was seen in 24% of rheumatoid factor (RF)-positive and 36% of RF-negative patients (p = 0.03). Logistic regression analysis for predictors of remission identified age at baseline, HAQ <1.63, and RF negativity as positive predictors of remission at 6 months along with sex (male). Conclusion. We show that only a minority of patients with longstanding RA achieve a good clinical response or remission at the outpatient community level. Predictors of remission identify characteristics commonly observed in subsets with less severe RA.

KW - Disability score

KW - Good clinical response

KW - Remission

KW - Rheumatoid arthritis

KW - Tumor necrosis factor-α blockers

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