In patients with rheumatoid arthritis (RA), use of connected monitoring via a mobile application, together with support from a clinical case manager, has demonstrated benefits in disease management, including fewer physical visits while maintaining tight control and improved quality of life among those initiating a new disease-modifying antirheumatic drug (DMARD) therapy. Results of the analysis were published in the journal Rheumatology (Oxford).
A 6-month, pragmatic, randomized, controlled, open-label, monocentric, prospective clinical trial (ClinicalTrials.gov identifier: NCT03005925) was conducted among patients with RA between April 2017 and August 2019. The investigators sought to evaluate outcomes of patients with an RA flare assigned to be monitored by a connected interface on a smartphone (SATIE-PR application) vs those assigned to routine conventional monitoring. They established 2 groups of patients—connected monitoring (ie, telemedicine) and conventional monitoring (ie, routine practice). The primary study outcome was the total number of intermediate physical visits to the hospital that occurred between baseline and 6 months. Secondary study outcome measures included satisfaction, adherence, safety, and changes in clinical, functional, and health status scores (Short-Form 12). a total of 94 patients were randomized, with 89 completing the study—44 in the conventional monitoring arm and 45 in the connected monitoring arm.
Results of the study showed that only 4.4% (2 of 45) of the participants in the connected monitoring arm compared with 86.4% (38 of 44) of those in the conventional monitoring arm had ≥2 physical visits during the 6-month study period (P <.01), which resulted in significantly fewer intermediate physical visits in the connected monitoring group compared with the conventional monitoring group (0.42±0.58 vs 1.93±0.55, respectively; P <.05).
Conversely, the number of phone call visits was significantly higher in the connected monitoring arm than in the conventional monitoring arm (2.67±2.58 vs 0.41±1.19, respectively; P <.01). In fact, only 15.6% ( 7 of 45) of patients did not require phone call visits in the conventional monitoring arm compared with 79.6% (35 of 44) of those in the conventional monitoring arm (P <.01). Based on an analysis of the total number of visits (ie, the sum of physical and phone call visits), no statistically significant difference was observed between the groups (P =.29). However, 31.1% (14 of 45) of patients in the connected monitoring group reported ≥4 total visits compared with 9.1% (4 of 44) of those in the conventional monitoring group (P <.01).
Limitations of this study include the monocentric design and the short-term duration of the study does not allow for evaluation of long-term benefits of connected monitoring.
The investigators concluded that the use of a connected monitoring approach in patients with RA who are beginning treatment with a new DMARD has been shown to reduce the number of physician visits while, at the same time, maintaining tight control of disease activity and enhancing quality of life. They did make note of the fact that the medico-economic consequences of this connected monitoring approach have yet to be determined.
Pers Y-M, Valsecchi V, Mura T, et al. A randomized prospective open-label controlled trial comparing the performance of a connected monitoring interface versus physical routine monitoring in patients with rheumatoid arthritis. Rheumatology (Oxford). Published online October 6, 2020. doi:10.1093/rheumatology/keaa462