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Predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA): results from a randomized trial.

Levitsky, A ; Forslind, Kristina LU and van Vollenhoven, R. F. (2015) In Scandinavian Journal of Rheumatology 44(5). p.53-348
Abstract
OBJECTIVES:
The aim of this study was to apply a previously published method for evaluating radiographic progression, namely, predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA), to the Swedish pharmacotherapy (SWEFOT) trial.
METHOD:
In SWEFOT, 487 patients with eRA were given methotrexate (MTX), and non-responders were randomized to group A [triple therapy: MTX+sulfasalazine (SSZ)+hydroxychloroquine (HCQ)] and group B [anti-tumour necrosis factor (anti-TNF) therapy: MTX+infliximab]. Responders continued on MTX. Predicted progression for 343 eligible patients was calculated based on the baseline total Sharp/van der Heijde score (SHS) divided by symptom duration, compared to observed... (More)
OBJECTIVES:
The aim of this study was to apply a previously published method for evaluating radiographic progression, namely, predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA), to the Swedish pharmacotherapy (SWEFOT) trial.
METHOD:
In SWEFOT, 487 patients with eRA were given methotrexate (MTX), and non-responders were randomized to group A [triple therapy: MTX+sulfasalazine (SSZ)+hydroxychloroquine (HCQ)] and group B [anti-tumour necrosis factor (anti-TNF) therapy: MTX+infliximab]. Responders continued on MTX. Predicted progression for 343 eligible patients was calculated based on the baseline total Sharp/van der Heijde score (SHS) divided by symptom duration, compared to observed progression at 12 and 24 months.
RESULTS:
Observed radiographic progression was reduced from predicted by a mean of 50.1% (A), 72.3% (B), and 73.9% (MTX) at 12 months and by 87.2, 89.8, and 87.8% at 24 months, respectively. Among completers, reductions of 56.7% (A) and 76.5% (B) at 12 months and of 91.0% and 96.0% at 24 months, respectively, were observed. At 12 months, there were no significant between-group differences. At 24 months, progression was reduced more in group B than in group A (first quartile difference 8.5% favouring group B) and in MTX [n=316, 89.8% (sd±32.0) vs. 87.2% (±32.2), p=0.021; vs. 87.8% (±27.8), p=0.013, respectively].
CONCLUSIONS:
The POPeRA method confirms the original SWEFOT finding in that anti-TNF therapy was statistically marginally superior (2.6%) to triple therapy in preventing radiographic progression at 24 months among initial MTX non-responders. The simulation provided through POPeRA may facilitate comparisons of the relative efficacy of various treatments in preventing radiographic progression. (Less)
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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Rheumatology
volume
44
issue
5
pages
53 - 348
publisher
Taylor & Francis
external identifiers
  • scopus:84943256934
ISSN
1502-7732
DOI
10.3109/03009742.2015.1019560
language
English
LU publication?
yes
id
f8f36cf6-9b06-428a-91a5-48876b2d7e54
date added to LUP
2019-06-28 14:41:13
date last changed
2024-01-01 14:12:21
@article{f8f36cf6-9b06-428a-91a5-48876b2d7e54,
  abstract     = {{OBJECTIVES:<br/>The aim of this study was to apply a previously published method for evaluating radiographic progression, namely, predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA), to the Swedish pharmacotherapy (SWEFOT) trial.<br/>METHOD:<br/>In SWEFOT, 487 patients with eRA were given methotrexate (MTX), and non-responders were randomized to group A [triple therapy: MTX+sulfasalazine (SSZ)+hydroxychloroquine (HCQ)] and group B [anti-tumour necrosis factor (anti-TNF) therapy: MTX+infliximab]. Responders continued on MTX. Predicted progression for 343 eligible patients was calculated based on the baseline total Sharp/van der Heijde score (SHS) divided by symptom duration, compared to observed progression at 12 and 24 months.<br/>RESULTS:<br/>Observed radiographic progression was reduced from predicted by a mean of 50.1% (A), 72.3% (B), and 73.9% (MTX) at 12 months and by 87.2, 89.8, and 87.8% at 24 months, respectively. Among completers, reductions of 56.7% (A) and 76.5% (B) at 12 months and of 91.0% and 96.0% at 24 months, respectively, were observed. At 12 months, there were no significant between-group differences. At 24 months, progression was reduced more in group B than in group A (first quartile difference 8.5% favouring group B) and in MTX [n=316, 89.8% (sd±32.0) vs. 87.2% (±32.2), p=0.021; vs. 87.8% (±27.8), p=0.013, respectively].<br/>CONCLUSIONS:<br/>The POPeRA method confirms the original SWEFOT finding in that anti-TNF therapy was statistically marginally superior (2.6%) to triple therapy in preventing radiographic progression at 24 months among initial MTX non-responders. The simulation provided through POPeRA may facilitate comparisons of the relative efficacy of various treatments in preventing radiographic progression.}},
  author       = {{Levitsky, A and Forslind, Kristina and van Vollenhoven, R. F.}},
  issn         = {{1502-7732}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{53--348}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Rheumatology}},
  title        = {{Predicted vs. observed radiographic progression in early rheumatoid arthritis (POPeRA): results from a randomized trial.}},
  url          = {{http://dx.doi.org/10.3109/03009742.2015.1019560}},
  doi          = {{10.3109/03009742.2015.1019560}},
  volume       = {{44}},
  year         = {{2015}},
}