Patient, physician discordance may impact outcomes in spondyloarthritis
medwireNews: Patients with spondyloarthritis are less likely to remain on tumor necrosis factor (TNF) inhibitor treatment and achieve remission if they disagree with their physicians on the level of their disease activity, researchers report in Rheumatology.
Brigitte Michelsen (Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark) and colleagues used registry data from 11 European countries to assess the outcomes of 14,868 individuals with spondyloarthritis – 9013 with axial spondyloarthritis (axSpA) and 5855 with psoriatic arthritis (PsA) – who initiated TNF inhibitor treatment between 2000 and 2017.
The team categorized patients into one of four groups based on discordance between patients’ and healthcare providers’ perceptions of baseline disease activity, calculated as patient-reported minus evaluator-reported global assessment of disease activity (ΔPEG).
Michelsen and co-authors identified a significant inverse association between patient–physician discordance and treatment retention rates at 6, 12, and 24 months, with the lowest retention rates seen among patients in the highest ΔPEG quartile; that is, those who rated disease activity higher than their healthcare providers with the greatest level of disagreement.
For example, 74% of 740 women with PsA in the highest quartile (ΔPEG 39 to 100) remained on their TNF inhibitor at 6 months, and this proportion rose to 81% for the 739 women in the third quartile (ΔPEG 18 to 38), 85% for the 694 in the second quartile (ΔPEG 1 to 17), and 87% for the 815 in the first quartile (ΔPEG –100 to 0). The corresponding proportions of women with axSpA remaining on TNF inhibitors at 6 months were 76%, 78%, 84%, and 88%.
The pattern was similar among men, and comparable results were seen at the 12- and 24-month timepoints for both sexes. The findings remained significant after adjustment for age, disease duration, and smoking.
Moreover, there was a significant inverse association between patient–physician discordance and the probability of achieving remission in both sexes at most timepoints among axSpA patients. For instance, those in higher quartiles of baseline ΔPEG were less likely to achieve BASDAI remission (<2.0 points) and ASDAS inactive disease (<1.3 points) than those in the lower quartiles.
For PsA, the association between ΔPEG and remission was only significant when patient global assessment was included in the definition of remission, which the researchers say highlights “the importance of including remission criteria that objectively reflect disease activity.”
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