Baseline Power Doppler Positivity Predicts Response to Advanced Therapies in Rheumatoid Arthritis
Notice bibliographique
Résumé
Objectives Our recent systematic literature review highlighted the controversies regarding the predictive value of baseline power Doppler (PD) positivity on ultrasound (US) for treatment response in rheumatoid arthritis (RA), likely due to the heterogeneity of the trials and outcome measures.[1] In this study, we aimed to explore the predictive factors of response to advanced therapies in RA and whether baseline PD positivity is an independent predictor of response, by testing different response measures. Methods RA patients were recruited from the ORCHESTRA (Ottawa Rheumatology CompreHEnSive Treatment and Assessment) Clinic, where all patients with RA about to initiate a new advanced therapy are assessed following a standardized protocol, including a protocolized US of 36 joints, at baseline and three-month intervals until clinical remission is achieved. The US scoring is based on the OMERACT-EULAR definitions, where grayscale synovitis and Doppler findings in each joint are scored on a scale of 0-3. For the analysis, having at least 1 joint with a Doppler score ≥2 was classified as the Doppler-positive group, and the rest was defined as the Doppler-negative group. The groups were compared for their Delta (D) DAS28CRP (baseline minus month-3), achieving Minimal clinically important difference (MCID) (DDAS28CRP ≥0.6) and DAS28CRP remission at follow-up. A multivariate analysis was performed to understand whether baseline PD positivity is an independent predictor of achieving MCID. Results Baseline: Of 101 patients, 80 (79.2%) were classified as Doppler-positive, and 21 (20.8%) were Doppler-negative. Demographics were similar between the groups (Table). There was a trend toward baseline DAS28CRP scores being higher in the Doppler-positive group and significantly more frequent erosions on x-rays. Follow-up: In the 3-month follow-up, the Doppler-positive group had significant reductions in their DAS28CRP scores (p<0.001); but not the Doppler-negative group (p= 0.22). DDAS28CRP was numerically higher and achieving MCID was significantly more common in Doppler-positive group (Table). The percentage of patients in DAS28CRP remission at follow-up was similar between Doppler-positive and negative patients. In multivariate analysis, baseline DAS28CRP and Doppler positivity were the only predictors of achieving MCID (Table). Table. Comparison of Doppler positive and negative groups and Predictors of treatment response during follow-up in RA patients Conclusion The baseline Doppler positivity independently predicts a better response to advanced therapies in RA. However, the response may not be enough to remission due to higher baseline disease activity. The Doppler-positive patients achieved MCID 3.8 more often than the Doppler negatives. Our data encourages conducting a prospective trial using US positivity in the decision-making process for advanced therapies in RA. [1.] Gazel U. Rheumatol Adv Pract (under review).
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,003 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».