DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients: validation of the DAS28 score in patients under infliximab treatment.
DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients: validation of the DAS28 score in patients under infliximab treatment.
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DOI：
10.1186/ar1787
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发表时间：
2005
影响因子：
4.9
通讯作者：
De Keyser F
中科院分区：
文献类型：
--
作者：
Vander Cruyssen B;Van Looy S;Wyns B;Westhovens R;Durez P;Van den Bosch F;Veys EM;Mielants H;De Clerck L;Peretz A;Malaise M;Verbruggen L;Vastesaeger N;Geldhof A;Boullart L;De Keyser F
本研究基于一项扩大使用计划，其中511例活动性难治性类风湿性关节炎（RA）患者在第0、2、6周和此后每8周一次接受英夫利西单抗（3 mg/kg+甲氨蝶呤（MTX））静脉输注治疗。在第22周，474例患者仍在随访中，其中102例（21.5%）对治疗反应不佳，从第30周开始接受剂量增加。我们的目的是建立一个模型来区分增加剂量的决定。这一决定是基于治疗的风湿病学家的临床判断，因此可以被认为是反应不足的临床指标。模型构建考虑了第0、6、14和22周的不同单一和复合测量值及其随时间的差异。基于受试者工作特征（ROC）曲线分析的曲线下面积对连续变量进行排序，显示瞬时DAS 28（疾病活动性评分，包括28个关节计数）是最重要的区分变量。随后，我们证明了反应分数和随着时间的推移的变化是不太重要的比瞬间的评价，以区分医生的决定。因此，我们获得的最终模型是一个仅比DAS 28具有略好的判别特征的模型。最后，我们使用DAS 28的单个变量拟合了判别函数。这显示了与DAS 28相似的评分和系数。总之，我们评估了不同的变量和模型，以区分治疗风湿病学家决定增加英夫利西单抗（+MTX）的剂量，这表明RA患者对3 mg/kg英夫利西单抗的反应不足。我们证明了瞬时DAS 28评分与这一决定的相关性最好，并证明了在接受英夫利西单抗治疗的RA患者队列中DAS 28评分和系数的稳健性。
This study is based on an expanded access program in which 511 patients suffering from active refractory rheumatoid arthritis (RA) were treated with intravenous infusions of infliximab (3 mg/kg+methotrexate (MTX)) at weeks 0, 2, 6 and every 8 weeks thereafter. At week 22, 474 patients were still in follow-up, of whom 102 (21.5%), who were not optimally responding to treatment, received a dose increase from week 30 onward. We aimed to build a model to discriminate the decision to give a dose increase. This decision was based on the treating rheumatologist's clinical judgment and therefore can be considered as a clinical measure of insufficient response. Different single and composite measures at weeks 0, 6, 14 and 22, and their differences over time were taken into account for the model building. Ranking of the continuous variables based on areas under the curve of receiver-operating characteristic (ROC) curve analysis, displayed the momentary DAS28 (Disease Activity Score including a 28-joint count) as the most important discriminating variable. Subsequently, we proved that the response scores and the changes over time were less important than the momentary evaluations to discriminate the physician's decision. The final model we thus obtained was a model with only slightly better discriminative characteristics than the DAS28. Finally, we fitted a discriminant function using the single variables of the DAS28. This displayed similar scores and coefficients as the DAS28. In conclusion, we evaluated different variables and models to discriminate the treating rheumatologist's decision to increase the dose of infliximab (+MTX), which indicates an insufficient response to infliximab at 3 mg/kg in patients with RA. We proved that the momentary DAS28 score correlates best with this decision and demonstrated the robustness of the score and the coefficients of the DAS28 in a cohort of RA patients under infliximab therapy.
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影响因子：
4.9
作者：
Aletaha D;Nell VP;Stamm T;Uffmann M;Pflugbeil S;Machold K;Smolen JS
通讯作者：
Smolen JS
影响因子：
--
作者：
Clair, EWS;Wagner, CL;Keystone, EC
通讯作者：
Keystone, EC
影响因子：
1.9
作者：
Pepe, MS;Longton, G;Schummer, M
通讯作者：
Schummer, M
影响因子：
5.5
作者：
den Broeder, AA;Creemers, MCW;van Riel, PLCM
通讯作者：
van Riel, PLCM
DOI：
10.1016/j.berh.2003.09.011
发表时间：
2004-02-01
影响因子：
5.2
作者：
Fransen, J;van Riel, PLCM
通讯作者：
van Riel, PLCM