Predictive model to identify multiple failure to biological therapy in patients with rheumatoid arthritis.

Background

Despite advances in the treatment of rheumatoid arthritis (RA) and the wide range of therapies available, there is a percentage of patients whose treatment presents a challenge for clinicians due to lack of response to multiple biologic and target-specific disease-modifying antirheumatic drugs (b/tsDMARDs).

Objective

To develop and validate an algorithm to predict multiple failure to biological therapy in patients with RA.

Design

Observational retrospective study involving subjects from a cohort of patients with RA receiving b/tsDMARDs.

Methods

Based on the number of prior failures to b/tsDMARDs, patients were classified as either multi-refractory (MR) or non-refractory (NR). Patient characteristics were considered in the statistical analysis to design the predictive model, selecting those variables with a predictive capability. A decision algorithm known as 'classification and regression tree' (CART) was developed to create a prediction model of multi-drug resistance. Performance of the prediction algorithm was evaluated in an external independent cohort using area under the curve (AUC).

Results

A total of 136 patients were included: 51 MR and 85 NR. The CART model was able to predict multiple failures to b/tsDMARDs using disease activity score-28 (DAS-28) values at 6 months after the start time of the initial b/tsDMARD, as well as DAS-28 improvement in the first 6 months and baseline DAS-28. The CART model showed a capability to correctly classify 94.1%

Conclusion

Our model correctly classified

Informations de copyright

© The Author(s), 2022.

Déclaration de conflit d'intérêts

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: D.P., C.T., V.R.-E., C.A.C., and M.D.-A. have nothing to declare. M.N.-N. reports grants from UCB, Lilly and Janssen outside the submitted work. D.B. reports grants from Roche, AbbVie, and Novartis outside the submitted work. A.V. reports grants from Janssen outside the submitted work. R.S. reports grants from Abbvie, BMS, Gebro-Pharma, Lilly, MSD, Pfizer, Sanofi, and Roche outside the submitted work. C.P.-R. reports grants from Abbvie, Pfizer, Novartis, Lilly and Roche outside the submitted work. A.B. reports grants from Abbvie, Amgen, Pfizer, Galapagos, Novartis, Gilead, BMS, Nordic, Sanofi, Sandoz, Lilly, UCB, and Roche outside the submitted work.