Newsletter Rhumatologues N°27

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter rhumatologues rédigée par le Pr F Berenbaum, rhumatologue à Saint Antoine .
Pour y avoir accès, merci de consulter le lien suivant: cliquer ici.

Newsletter Patient N°18

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr C Miceli, rhumatologue au CHU de Cochin.
Pour y avoir accès, merci de cliquer ici.

Newsletter Patient N°17

Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr L. Gossec, rhumatologue au CHU La pitié Salpêtrière.
Pour y avoir accès, merci de cliquer ici.

Newsletter Patient N°16

Bonjour,
Nous mettons en ligne aujourd’hui la nouvelle Newsletter patients rédigée par le Pr P Claudepierre , rhumatologue au CHU Henri Mendor.
Pour y avoir accès, merci de cliquer ici.

Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis

Un nouvel article scientifique intitulé «Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis.» a été publié dans le journal Ann Rheum Dis .

Dougados M, Maksymowych W, Landewé RB, Moltó A, Claudepierre P, de Hooge M, Lambert RG, Bonin R, Bukowski JF, Jones HE, Logeart I, Pedersen R, Szumski A, Vlahos B, van der Heijde D.

Abstract

OBJECTIVE:

To compare 2 years of radiographic sacroiliac joint (SIJ) changes in patients with recent onset axial spondyloarthritis (axSpA) receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving biologics in a cohort study (DESIR).

METHODS:

Endpoints were changes at week 104 per the modified New York (mNY) grading system in total SIJ score (primary endpoint) and net percentage of patients with progression defined three ways. Treatment effect was analysed with and without adjustment for baseline covariates.

RESULTS:

At 104 weeks, total SIJ score improved in the etanercept group (n=154, adjusted least-squares mean change: -0.14) and worsened in the control group (n=182, change: 0.08). The adjusted difference between groups (etanercept minus control) was -0.22 (95% CI -0.38 to -0.06), p=0.008. The net percentage of patients with progression was significantly lower in the etanercept versus the control group for two of three binary endpoints: -1.9% versus 1.6% (adjusted difference for etanercept minus control: -4.7%,95% CI -9.9 to 0.5, p=0.07) for change in mNY criteria; -1.9% versus 7.8% (adjusted difference: -18.2%,95% CI -30.9 to -5.6, p=0.005) for change ≥1 grade in ≥1 SIJ; and -0.6% versus 6.7% (adjusted difference: -16.4%,95% CI -27.9 to -5.0, p=0.005) for change ≥1 grade in ≥1 SIJ, with shift from 0 to 1 or 1 to 0 considered no change.

CONCLUSION:

Despite the slow radiographic SIJ progression rate over 2 years in axSpA, this study suggests a lower rate of progression in the SIJ with etanercept than without anti-tumour necrosis factor therapy.
TRIAL REGISTRATION NUMBERS:

NCT01258738,NCT01648907; Post-results.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

KEYWORDS:

anti-tnf; spondyloarthritis; treatment

Classification criteria versus physician’s opinion for considering a patient with inflammatory back pain as suffering from spondyloarthritis

Un nouvel article scientifique intitulé «Classification criteria versus physician’s opinion for considering a patient with inflammatory back pain as suffering from spondyloarthritis.» a été publié dans le journal Joint Bone Spine.

Gazeau P, Cornec D, Timsit MA, Dougados M, Saraux A.

Abstract

OBJECTIVE:

To assess agreement among methods for classifying patients with inflammatory back pain (IBP) after a 2-year follow-up.

METHODS:

Patients with IBP in the French nationwide, longitudinal, prospective cohort DESIR were classified after 2years based on imaging findings, rheumatologist’s confidence in a diagnosis of spondyloarthritis, three classification criteria sets (axial Assessment of Spondyloarthritis international Society [ASAS], European Spondylarthropathy Study Group [ESSG], and Amor) and treatment (TNFα antagonists). Agreement among these methods was assessed by computing the percentage of concordant classifications and Cohen’s kappa coefficient. Using logistic regression, we identified the items most strongly associated with rheumatologist’s confidence.

RESULTS:

Agreement among criteria sets was poor (kappa<0.6), even in the group with inflammation by magnetic resonance imaging. Of 708 patients, 541 had all available data including rheumatologist’s confidence after 2years, which was 0/10 for 31 (5.7%) patients, 1/10 to 7/10 for 158 (29.2%) patients, 8/10 or 9/10 for 167 (30.9%) patients, and 10/10 for 185 (34.2%) patients. TNFα antagonists were used in 156/356 (43.8%) patients in the two highest confidence groups versus 53/188 (28.2%) patients in the two lowest confidence groups. Factors independently associated with confidence ≥8/10 were fulfilment of ASAS, ESSG, and Amor criteria.

CONCLUSION:

Confidence of rheumatologists in the diagnosis of spondyloarthritis in patients with recent-onset IBP shows limited agreement with classification criteria. The best way to currently classify spondyloarthritis should be the association of both at least one classification criteria and a diagnosis of spondyloarthritis according to the rheumatologist.

KEYWORDS:

Ankylosing spondylitis; Axial spondyloarthritis; Sacro-iliitis

Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort

Un nouvel article scientifique intitulé «Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort.» a été publié dans le journal Ann Rheum Dis.

Dougados M, Sepriano A, Molto A, van Lunteren M, Ramiro S, de Hooge M, van den Berg R, Navarro Compan V, Demattei C, Landewé R, van der Heijde D.

Ann Rheum Dis. 2017 Jul 6. pii: annrheumdis-2017-211596. doi: 10.1136/annrheumdis-2017-211596. [Epub ahead of print]


Abstract
OBJECTIVE:

To estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression.
METHODS:

X-SIJ and MRI-SIJ at baseline and after 2 and 5 years in patients with recent onset axSpA from the DESIR cohort were scored by three central readers. Progression was defined as (1) the shift from non-radiographic (nr) to radiographic (r) sacroiliitis (by modified New York (mNY) criteria) or alternative criteria, (2) a change of at least one grade or (3) a change of at least one grade but ignoring a change from grade 0 to 1. The effects of baseline inflammation on MRI-SIJ on 5-year X-SIJ damage (mNY) were tested by generalised estimating equations.
RESULTS:

In 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients.
CONCLUSIONS:

Five-year progression of X-SIJ damage in patients with recent onset axSpA is limited but present beyond measurement error. Baseline MRI-SIJ inflammation drives 5-year radiographic changes.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS:

epidemiology; magnetic resonance imaging; outcomes research; spondyloarthritis

The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts

Un nouvel article scientifique intitulé «The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts» a été publié dans le journal Ann Rheum Dis.

Ez-Zaitouni Z, Bakker PA, van Lunteren M, de Hooge M, van den Berg R, Reijnierse M, Fagerli KM, Landewé RB, Ramonda R, Jacobsson LT, Saraux A, Lenczner G, Feydy A, Pialat JB, Thévenin F, van Gaalen FA, van der Heijde D.

OBJECTIVES:

To assess the prevalence of spinal inflammation on MRI in patients with chronic back pain (CBP) of maximally 3 years duration and to evaluate the yield of adding a positive MRI-spine as imaging criterion to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA).

METHODS:

Baseline imaging of the sacroiliac joints (X-SI), MRI of the sacroiliac joints (MRI-SI) and MRI-spine were scored by ≥2 experienced central readers per modality in the SPondyloArthritis Caught Early (SPACE) and DEvenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohorts. Inflammation suggestive of axSpA was assessed in the entire spine. A positive MRI-spine was defined by the presence of ≥5 inflammatory lesions. Alternative less strict definitions were also tested.

RESULTS:

In this study, 541 and 650 patients with CBP from the SPACE and DESIR cohorts were included. Sacroiliitis on X-SI and MRI-SI was found in 40/541 (7%) and 76/541 (14%) patients in SPACE, and in DESIR in 134/650 (21%) and 231/650 (36%) patients, respectively. In SPACE and DESIR, a positive MRI-spine was seen in 4/541 (1%) and 48/650 (7%) patients. Of the patients without sacroiliitis on imaging, 3/447 (1%) (SPACE) and 8/382 (2%) (DESIR) patients had a positive MRI-spine. Adding positive MRI-spine as imaging criterion led to new classification in only one patient in each cohort, as the other patients already fulfilled the clinical arm. Other definitions of a positive MRI-spine yielded similar results.

CONCLUSION:

In two cohorts of patients with CBP with a maximum symptom duration of 3 years, a positive MRI-spine was rare in patients without sacroiliitis on MRI-SI and X-SI. Addition of MRI-spine as imaging criterion to the ASAS axSpA criteria had a low yield of newly classified patients and is therefore not recommended.

KEYWORDS:

ankylosing spondylitis; axial spondyloarthritis; classification criteria; magnetic resonance imaging

Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort

Un nouvel article scientifique intitulé «Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR Cohort.» a été publié dans le journal J Rheumatol.

Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis AH.

Abstract

OBJECTIVE:

To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indifférenciées Récentes).

METHODS:

Using alternate definitions of adherence, patients were classified as adherent « timely » anti-TNF users, nonadherent « late » anti-TNF users, adherent nonusers ( »no anti-TNF need »), non-adherent nonusers ( »unmet anti-TNF need »). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a γ-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes.

RESULTS:

Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54-1.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44-1.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06-2.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (-0.04, 95% CI -0.07 to -0.01, p = 0.016).

CONCLUSION:

The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.

KEYWORDS:

ADHERENCE; ANKYLOSING SPONDYLITIS; ANTI-TNF; ECONOMIC; QUALITY OF LIFE; SPONDYLOARTHRITIS

Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates.

Un nouvel article scientifique intitulé «Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates.» a été publié dans le journal Cost Eff Resour Alloc.

Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis A.

Abstract

BACKGROUND:
Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria on anti-TNF cost-effectiveness is unknown. Our objective was to use data from the DESIR cohort, a prospective study of early SpA patients in France, to determine whether the French anti-TNF access criteria are the most cost-effective in that setting relative to other potential restrictions.

METHODS:
We used data from the DESIR cohort to create five study populations of patients meeting anti-TNF access criteria from Canada, France, Germany, United Kingdom, and Hong Kong, respectively. For each study population, we calculated the costs and quality-adjusted life years (QALYs) over 1 year of patients treated and not treated with anti-TNF therapy. To control for differences between anti-TNF users and non-users, we used linear regression models to derive adjusted mean costs and QALYs. We calculated incremental cost-effectiveness ratios (ICERs) representing the incremental cost per additional QALY gained by treating with an anti-TNF within each of the five study populations, using bootstrapping to explore the range of uncertainty in costs and QALYs. A series of sensitivity analyses was conducted, including one to simulate the effect of a 24-week stopping rule for anti-TNF non-responders.

RESULTS:

Anti-TNF access criteria from France were satisfied by the largest proportion of DESIR patients (27.8%), followed by Germany (25.1%), Canada (23.8%), the UK (12.1%) and Hong Kong (8.6%). Confidence intervals around incremental costs and QALYs in the basecase analysis were overlapping, indicating that anti-TNF cost-effectiveness estimates derived from each subset were similar. In the sensitivity analysis that examined the effect of excluding costs accumulated past 24 weeks by anti-TNF non-responders, the incremental cost per QALY was reduced by approximately 25% relative to the basecase analysis (France: €857,992 vs. €1,105,859; Canada: € 626,459 vs. €818,186; Germany: € 422,568 vs. €545,808); UK €578,899 vs. €766,217; Hong Kong €335,418 vs. €456,850).

CONCLUSIONS:

Anti-TNF cost-effectiveness is strongly affected by treatment continuation among non-responders. Access criteria could improve anti-TNF cost-effectiveness by defining patients likely to respond.

KEYWORDS:

Anti-TNF; Biologics; Cost-effectiveness; Pharmaceutical policy; Spondyloarthritis