The multibiomarker disease activity (MBDA) score may be an objective tool for monitoring rheumatoid arthritis (RA), according to findings of a systematic review and meta-analysis published in Rheumatology.
Currently, 3 disease monitoring instruments (Disease Activity Score with 28-joint count [DAS28], Simplified Disease Activity Index [SDAI], and Clinical Disease Activity Index [CDAI]) are commonly used for monitoring disease activity in RA; however, all of them use subjective assessments. The MBDA score was developed based on biomarker levels and may be a more quantitative approach for monitoring disease.
To evaluate the role of MBDA scores for RA monitoring, researchers from Semmelweis University in Hungary searched 5 publication databases through October 2021 for studies reporting the correlation between MBDA score and disease activity measures, and the predictive and discriminative value of the MDBA score for radiographic progression, response to therapy, remission, and relapse.
A total of 24 and 8 studies were included in the quantitative and qualitative assessments, respectively.
Significant correlations were observed between MBDA scores and DAS28 C-reactive protein (CRP) levels at baseline (r=0.45; 95% CI, 0.28-0.59; I2=71.0%), at follow-up (r=0.44; 95% CI, 0.28-0.57; I2=70.0%), and for the change in both scores (r=0.40; 95% CI, 0.32-0.48; I2=19%).
The MBDA scores also correlated with DAS28 erythrocyte sedimentation rate (ESR) at baseline (r=0.55; 95% CI, 0.19-0.78; I2=0.0%), at follow-up (r=0.49; 95% CI, 0.22-0.69), and for the change in both scores (r=0.56; 95% CI, 0.51-0.60; I2=71.0%).
A significant association between MBDA scores and radiologic progression were observed (odds ratio [OR], 1.03; 95% CI, 1.02-1.05; I2=10.0%).
However, MDBA scores were not correlated with Sharp/van der Heijde (SvdH) scores at baseline (r=0.13; 95% CI, -0.25 to 0.47; I2=79.0%) or change in SvdH (r=0.08; 95% CI, -0.06 to 0.21; I2=79.0%).
In the qualitative assessment, the researchers reported that the change in MBDA score was associated with favorable European Alliance of Associations for Rheumatology (EULAR) response at 6 months; MBDA score distinguished between disease activity and remission status; and MBDA score at baseline was positively correlated with relapse at follow-up.
The major limitation of the analysis was the high heterogeneity observed in data.
“The MBDA score can be highly valuable in RA patient care, both for monitoring disease activity and for predicting radiological progression. However, further studies are needed to better assess the utility of the MBDA score and also the potential role of individual biomarkers in disease activity monitoring,” the study authors concluded.
Meznerics FA, Kemény LV, Gunther E, et al. Multi-biomarker disease activity score: an objective tool for monitoring rheumatoid arthritis? A systematic review and meta-analysis. Rheumatology. Published online December 23, 2022. doi:10.1093/rheumatology/keac715