Prediction of sustained biologic and targeted synthetic DMARD-free remission in rheumatoid arthritis patients

Theresa Burkard; Ross D Williams; Enriqueta Vallejo-Yagüe; Thomas Hügle; Axel Finckh; Diego Kyburz; Andrea M Burden

doi:10.1093/rap/rkab087

Prediction of sustained biologic and targeted synthetic DMARD-free remission in rheumatoid arthritis patients

Rheumatol Adv Pract. 2021 Nov 13;5(3):rkab087. doi: 10.1093/rap/rkab087. eCollection 2021.

Authors

Theresa Burkard¹, Ross D Williams², Enriqueta Vallejo-Yagüe¹, Thomas Hügle³, Axel Finckh⁴, Diego Kyburz⁵, Andrea M Burden¹

Affiliations

¹ Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland.
² Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands.
³ Department of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne.
⁴ Department of Rheumatology, University Hospitals Geneva, Geneva.
⁵ Department of Rheumatology, University Hospital Basel, Basel, Switzerland.

Abstract

Objectives: The aim was to develop a prediction model of sustained remission after cessation of biologic or targeted synthetic DMARD (b/tsDMARD) in RA.

Methods: We conducted an explorative cohort study among b/tsDMARD RA treatment episode courses stopped owing to remission in the Swiss Clinical Quality Management registry (SCQM; 2008-2019). The outcome was sustained b/tsDMARD-free remission of ≥12 months. We applied logistic regression model selection algorithms using stepwise, forward selection, backward selection and penalized regression to identify patient characteristics predictive of sustained b/tsDMARD-free remission. We compared c-statistics corrected for optimism between models. The three models with the highest c-statistics were validated in new SCQM data until 2020 (validation dataset).

Results: We identified 302 eligible episodes, of which 177 episodes (59%) achieved sustained b/tsDMARD-free remission. Two backward and one forward selection model, with eight, four and seven variables, respectively, obtained the highest c-statistics corrected for optimism of c = 0.72, c = 0.70 and c = 0.69, respectively. In the validation dataset (47 eligible episodes), the models performed with c = 0.99, c = 0.80 and c = 0.74, respectively, and excellent calibration. The best model included the following eight variables (measured at b/tsDMARD stop): RA duration, b/tsDMARD duration, other pain/anti-inflammatory drug use, quality of life (EuroQol), DAS28-ESR score, HAQ score, education, and interactions of RA duration and other pain/anti-inflammatory drug use and of b/tsDMARD duration and HAQ score.

Conclusion: Our results suggest that models with up to eight unique variables may predict sustained b/tsDMARD-free remission with good efficiency. External validation is warranted.

Keywords: Swiss Clinical Quality Management; biologic DMARD; biologics; remission; rheumatoid arthritis; targeted synthetic DMARD; treatment discontinuation.