In patients with psoriatic arthritis (PsA), the initial response to therapy has a highly significant predictive value of long-term outcomes as early as 3 months after implementation of treatment, according to the results of diagnostic testing analyses from the randomized controlled trial of golimumab (GO-REVEAL), published in Rheumatology.
The investigators used data from 216 patients from GO-REVEAL to perform their study. They used 3-month and 6-month disease activity treatment outcomes to elucidate the implications of early response. They used regression analyses to estimate the probabilities of attaining low disease activity. The Disease Activity Index for PsA (DAPSA) was used to assess disease activity.
DAPSA levels at 3 months were excellent predictors of disease activity at 6 months and at 1 year, with areas under the receiver operating characteristic curves of 0.92 and 0.88, respectively. If patients did not achieve at least moderate disease activity after 3 months of receiving golimumab therapy, the estimated probability for 6-month low disease activity was quantified as <22%. Similar data were observed with respect to early DAPSA response: Patients attaining a DAPSA of 85% at 3 months had an 84% probability of achieving 6-month low disease activity or remission. The study results were validated in an independent cohort study of infliximab-treated patients (IMPACT 2).
The results of this study demonstrate that 3 months after therapy initiation in patients with PsA, it is possible to assess the likelihood of achieving therapeutic goals. The investigators concluded that selection of the 3-month assessment in patients with PsA is essential for treatment adaptations and for providing guidance to rheumatologists who apply these strategies.
Schoels MM, Landesmann U, Alasti F, Baker D, Smolen JS, Aletaha D. Early response to therapy predicts 6-month and 1-year disease activity outcomes in psoriatic arthritis patients [published online February 22, 2018]. Rheumatology (Oxford). doi:10.1093/rheumatology/key004