Real-World Data Validates Minimal Disease Activity Index in PsA

Hand with PsA
Hand with PsA
Overall improvements in rates of minimal disease activity are achieved in patients with PsA when they are treated with anti-tumor necrosis factor agents

Overall improvements in rates of minimal disease activity (MDA) achieved in patients with psoriatic arthritis (PsA) treated with anti-tumor necrosis factor (TNF) agents in routine clinical care have been reported. Findings from the ongoing, prospective Biologic Treatment Registry Across Canada (BioTRAC), published in BMC Open, evaluated a group of patients with PsA who were receiving anti-TNF pharmacotherapy.

A total of 223 patients with PsA from 46 primary care Canadian rheumatology practices who were receiving either infliximab (IFX) or golimumab (GLM) were enrolled in the study.

MDA information on the participants was available at baseline, 6 months, and 12 months. MDA was defined as ≥5 of the following criteria: (1) 28-item tender joint count (TCJ28) ≤1; (2) 28-item swollen joint count (SJC28) ≤1; (3) Psoriasis Area and Severity Index (PASI) ≤1 or body surface area ≤3; (4) Pain Visual Analogue Scale (VAS) ≤15 mm; (5) patient’s global assessment (PtGA) (VAS) ≤20 mm; (6) Health Assessment Questionnaire (HAQ) ≤0.5; and (7) tender entheseal points ≤1.

MDA was achieved by 11.7% of patients at baseline, 43.5% of patients at 6 months, 44.8% of patients at 12 months, and 48.8% of patients at 6 or 12 months.

Of the patients who achieved MDA at 6 months, 75.7% experienced sustained MDA at 12 months. Lower baseline HAQ (odds ratio [OR], 0.210; 95% CI, 0.099-0.447; P <.001) and lower TJC28 (OR, 0.880; 95% CI, 0.804-0.964; P =.006) were both significant prognostic indicators of MDA achievement at 12 months of treatment.

Among MDA achievers, the most commonly unmet MDA criteria included patient-reported pain (25%), patient’s global assessment (15%), and Psoriasis Area and Severity Index (12%).

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The investigators concluded that nearly 50% of participants who received IFX or GLM therapy in routine clinical care achieved MDA within the first year of treatment.

Overall improvement in clinical parameters and disease activity was demonstrated in IFX-treated patients and GLM-treated patients during the 2-year follow-up.

This evidence supports the validity of MDA in real-world settings and its utility in patient management under routine clinical care.

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Rahman P, Zummer M, Bessette L, et al. Real-world validation of the minimal disease activity index in psoriatic arthritis: an analysis from a prospective, observational, biological treatment registry. BMJ Open. 2017;7(8):e016619.