Regression to the mean using the disease activity score in eligibility and response criteria for prescribing TNF-α inhibitors in adults with rheumatoid arthritis

被引:9
作者
Greenwood, M. C. [1 ]
Rathi, J.
Hakim, A. J.
Scott, D. L.
Doyle, D. V.
机构
[1] Whipps Cross Univ Hosp NHS Trust, Acad Rheumatol & Osteoporosis Unit, London E11 1NR, England
[2] Kings Coll London, Sch Med, Acad Dept Rheumatol, London SE5 9RJ, England
关键词
disease activity score; rheumatoid arthritis; regression to the mean; TNF-alpha; clinical guidelines;
D O I
10.1093/rheumatology/kem109
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. When patients with rheumatoid arthritis (RA) are selected to start TNF-alpha inhibitors on the basis of high disease activity scores (DAS), some of the fall in DAS will be due to regression to the mean (RTM). We have assessed the extent to which such RTIVI explains DAS improvements on TNF-a inhibitors in routine clinical practice. Methods. We retrospectively evaluated DAS28 scores that had been recorded as part of routine assessment for two RA cohorts. (i) Thirty-five patients receiving TNF-alpha inhibitors who had been assessed when starting TNF-a inhibitors, 9-21 months prior and 1.5-6 months post-treatment. (ii) One hundred and seventy-seven clinic patients assessed twice, a year apart in the years immediately before the introduction of TNF-alpha inhibitors. Results. In patients receiving TNF-a inhibitors, mean DAS fell 1.8 (95% confidence interval [CI] 1.3, 2.3) from baseline but only 0.9 (95% CI 0.4, 1.4) from the previous routine assessment. Twenty-four (69%) patients showed a fall in DAS of >1.2 from baseline but only 17 (49%) from the previous assessment. Regression analysis of results from the pre-biological era estimated that as much as 0.6 of the 1.8 apparent DAS response to TNF-a inhibitors might be accounted for by RTIVI. Conclusions. Assessing change in DAS from commencement of biological therapy may overestimate response, due to the impact of RTIVI and fluctuation in disease. Adequacy of response might be better assessed by serial assessments and a wider range of patient-centred outcomes.
引用
收藏
页码:1165 / 1167
页数:3
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