A retrospective observational study of effectiveness of sequential biologic and targeted synthetic DMARDs in psoriatic arthritis in the UK
Bibliographic record
Abstract
OBJECTIVES: Evidence evaluating effectiveness of biologic and targeted synthetic DMARDs (b/tsDMARDs) in adults with PsA after exposure to three or more b/tsDMARDs is lacking. We aimed to evaluate response to sequential lines of b/tsDMARDs. METHODS: In this multicentre retrospective observational study, 22 hospitals submitted data from routine clinic appointments of patients with PsA treated with b/tsDMARDs. Purposive sampling obtained a study population exposed to advanced lines of therapy. Effectiveness outcome measures (Psoriatic Arthritis Response Criteria [PsARC]/tender joint count [TJC]/swollen joint count [SJC]) at baseline and first follow-up (12-16 weeks) for each line were recorded. Odds of achieving PsARC in 2nd/3rd line were compared with 4th+ line. RESULTS: Four hundred and thirty-seven participants (163 male, 274 female) and 1459 treatment courses were included: 430 1st line, 633 2nd/3rd line and 396 4th+ line. The adjusted odds ratio (95% CI) for achieving PsARC in 1st line vs 2nd/3rd line was 1.91 (1.40, 2.60) and 4th+ line vs 2nd/3rd line was 1.13 (0.84, 1.55). There was no significant difference in change from baseline TJC/SJC between 2nd/3rd and 4th+ lines. CONCLUSION: In this cohort the highest chance of a positive PsARC response was to 1st line b/tsDMARD: twice the chance of response vs 2nd/3rd line. The chance of a positive PsARC response to 4th+ lines of b/tsDMARD was not significantly different from 2nd/3rd lines after adjustment. This indicates that patients in a UK cohort can continue to have a meaningful response to later lines of treatment. This is the first available evidence of response to later lines of b/tsDMARD treatment in PsA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".