Predictive factors of tumour necrosis inhibitor treatment persistence for rheumatoid arthritis: An observational study in 8052 patients - 18/01/20

Doi : 10.1016/j.jbspin.2019.10.004

Bruno Fautrel ^a,^b, Manon Belhassen ^c,^d,⁎ , Christophe Hudry ^e, Marie-Christine Woronoff-Lemsi ^f,^g, Laurie Levy-Bachelot ^h, Eric Van Ganse ^c,^d, Florence Tubach ^i,^j
^a Sorbonne universités, UPMC université Paris 06, GRC 08, 75006 Paris, France
^b Rheumatology department, Pitié-Salpétrière university hospital, AP–HP, 75013 Paris, France
^c PELyon, pharmacoépidemiologie Lyon, 69008 Lyon, France
^d HESPER 7425, health services and performance research, university Claude Bernard Lyon 1, 69008 Lyon, France
^e Hôpital Cochin, AP–HP, 75014 Paris, France
^f CHU Besançon, 25030 Besançon, France
^g COMUE UBFC, UMR Inserm 1098, université Franche-Comté, 25030 Besançon, France
^h Merck Sharp & Dohme, 92400 Paris, France
ⁱ Inserm, Institut Pierre Louis d’épidémiologie et de Santé Publique, Sorbonne université, 75013 Paris, France
^j Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, IPLESP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP–HP, 75013 Paris, France

^⁎Corresponding author. Pharmacoepidemiology, faculté d’odontologie, UCBL, 11, rue Guillaume Paradin, 69372 Lyon cedex 08, France.Pharmacoepidemiology, faculté d’odontologie, UCBL11, rue Guillaume ParadinLyon cedex 0869372France

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Highlights

•	A high reduction in US tophus size at M6 is associated with low probability of relapse after stopping gout prophylaxis.
•	Probability of relapse was increased with a reduction in tophus size<50% (odds ratio 3.35 [95% CI 0.98; 11.44]).
•	US follow-up may be useful for managing ULT and gout flare prophylaxis.

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Abstract

Objectives

To determine whether changes in ultrasonography (US) features of monosodium urate crystal deposition is associated with the number of gouty flares after stopping gout flare prophylaxis.

Methods

We performed a 1-year multicentre prospective study including patients with proven gout and US features of gout. The first phase of the study was a 6-month US follow-up after starting urate-lowering therapy (ULT) with gout flare prophylaxis. After 6 months of ULT, gout flare prophylaxis was stopped, followed by a clinical follow-up (M6 to 12) and ULT was maintained. Outcomes were the proportion of relapsing patients between M6 and M12 according to changes of US features of gout and determining a threshold decrease in tophus size according to the probability of relapse.

Results

We included 79 gouty patients (mean [±SD] age 61.8±14 years, 91% males, median disease duration 4 [IQR 1.5; 10] years). Among the 49 completers at M12, 23 (47%) experienced relapse. Decrease in tophus size≥50% at M6 was more frequent without than with relapse (54% vs. 26%, P=0.049). On ROC curve analysis, a threshold decrease of 50.8% in tophus size had the best sensitivity/specificity ratio to predict relapse. Probability of relapse was increased for patients with a decrease in tophus size <50% between M0 and M6 (OR 3.35 [95% confidence interval 0.98; 11.44]).

Conclusion

A high reduction in US tophus size is associated with low probability of relapse after stopping gout prophylaxis. US follow-up may be useful for managing ULT and gout flare prophylaxis.

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Keywords : Rheumatoid arthritis, Predictive factors, Persistence, Subcutaneous TNF inhibitors