Evidence map›Paper›PMID 27992691›Full record

ArticleArthritis & rheumatology (Hoboken, N.J.)2017

A Multi-Biomarker Disease Activity Score and the Choice of Second-Line Therapy in Early Rheumatoid Arthritis After Methotrexate Failure.

Karen Hambardzumyan, Saedis Saevarsdottir, Kristina Forslind, Ingemar F Petersson, Johan K Wallman, Sofia Ernestam, Rebecca J Bolce, Ronald F van Vollenhoven

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Arthritis & rheumatology (Hoboken, N.J.), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 1 pooled it
4.2field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 2 countries.

Karen HambardzumyanKarolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Saedis SaevarsdottirKarolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Kristina ForslindLund University and Helsingborg's Lasarett, Helsingborg, Sweden.
Ingemar F PeterssonLund University, Lund, Sweden.
Johan K WallmanLund University, Lund, Sweden.
Sofia ErnestamInstitution LIME Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Rebecca J BolceCrescendo Bioscience, Inc., South San Francisco, California.
Ronald F van VollenhovenKarolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Karolinska Institutet · SEKarolinska University Hospital · SELund University · SEHelsingborgs lasarett · SEScienceSouth · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate whether the Multi-Biomarker Disease Activity (MBDA) score predicts optimal add-on treatment in patients with early rheumatoid arthritis (RA) who were inadequate responders to MTX (MTX-IRs).

methodsWe analyzed data from 157 MTX-IRs (with a Disease Activity Score using the erythrocyte sedimentation rate [DAS28-ESR] >3.2) from the Swedish Pharmacotherapy (SWEFOT) trial who were randomized to receive triple therapy (MTX plus sulfasalazine plus hydroxychloroquine) versus MTX plus infliximab. The MBDA score as a predictor of the subsequent DAS28-based response to each second-line treatment was analyzed at randomization with the Breslow-Day test for 2 × 2 groups, using both validated categories (low [<30], moderate [30-44], and high [>44]) and dichotomized categories (lower [≤38] versus higher [>38]).

resultsAmong the 157 patients, 12% had a low MBDA score, 32% moderate, and 56% high. Of those with a low MBDA score, 88% responded to subsequent triple therapy, and 18% responded to MTX plus infliximab (P = 0.006); for those with a high MBDA score, the response rates were 35% and 58%, respectively (P = 0.040). When using 38 as a cutoff for the MBDA score (29% patients with lower scores versus 71% with higher scores), the differential associations with response to triple therapy versus MTX plus infliximab were 79% versus 44% and 36% versus 58%, respectively (P = 0.001). Clinical and inflammatory markers had poorer predictive capacity for response to triple therapy or MTX plus infliximab.

conclusionIn patients with RA who had an inadequate response to MTX, the MBDA score categories were differentially associated with response to subsequent therapies. Thus, patients with post-MTX biochemical improvements (lower MBDA scores) were more likely to respond to triple therapy than to MTX plus infliximab. If confirmed, these results may help to improve treatment in RA.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidBiomarkersBlood SedimentationChitinase-3-Like Protein 1C-Reactive ProteinDecision Support TechniquesDrug Therapy, CombinationEpidermal Growth FactorFemaleHumansHydroxychloroquineInfliximabInterleukin-6LeptinMaleAntirheumatic AgentsBiomarkersCHI3L1 protein, humanChitinase-3-Like Protein 1C-Reactive ProteinEpidermal Growth FactorHydroxychloroquineIL6 protein, humanInfliximabInterleukin-6LeptinMatrix Metalloproteinase 1Matrix Metalloproteinase 3MethotrexateMMP1 protein, humanMMP3 protein, humanReceptors, Tumor Necrosis Factor, Type IResistinRETN protein, humanSerum Amyloid A ProteinSulfasalazineVascular Cell Adhesion Molecule-1Vascular Endothelial Growth Factor AVEGFA protein, human

Identifiers

PMID27992691
PMCPMC5516230
OpenAlexW2564159582

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.