Dr. Leslie Harrold Talks Corrona Registry, Prognosis Factors, and “Walking the journey” with RA Patients

NOVEMBER 17, 2016
Ryan Black
Since its inception in 2001, the Corrona RA Registry has grown to become the largest prospective rheumatoid arthritis (RA) study in the world, with over 40,000 patients enrolled. It is used as the foundation of countless research efforts on the prevalence and treatment of the painful rheumatic condition. At the 2016 American College of Rheumatology Annual Meeting in Washington, DC, Leslie Harrold, MD, was on hand to present the findings of a few of these new studies. Harrold is a Senior Medical Director of Pharmacoepidemiology and Outcomes Research for the Corrona Registry.
Dr. Harrold’s team displayed a number of posters at the Meeting. A pair of them examined challenges and outcomes for RA patients with poor prognosis factors. “There hasn’t been a lot of work on poor prognosis,” she told MD Magazine in an interview, “What we chose to use were the poor prognosis characteristics that were included in the 2008 RA treatment recommendations put out by the American College of Rheumatology. They suggested you alter your treatment based on these characteristics.”
The poor prognosis factors her team examined were functional status, or how well an RA patient can function in daily life; seropositivity; x-rays that showed erosive disease; and extra-articular manifestations, such as RA lung disease/nodules or Sjögren’s syndrome.
One of the two examined if the presence of such factors in patients had an impact on their physicians’ treatment decisions. Out of a cohort of 3,621 patients with RA who were biologic naïve, they found that 42.9% had 0 or 1 poor prognosis factors, meaning the majority in the study had multiple. 34.9% displayed 2 factors, while 22.2% showed 3 or more. One outcome in they examined was the initiation of treatment with any disease-modifying antirheumatic drug (DMARD) and change in disease activity based on clinical disease activity index (CDAI)
“In 2008 the ACR did tell rheumatologists they need to consider poor prognostic factors when discussing patients’ treatment regimens. In the subsequent ACR treatment guidelines, they took that out,” she says, “So we did analysis to see if physicians are using poor prognosis factors to determine whether they initiate a biologic or change any therapy to accelerate care.”
When adjusting for baseline CDAI scores and disease factors, there was no significant relationship between poor prognosis and new DMARD use.
“We found that, no, physicians aren’t taking into account poor prognoses when making treatment decisions. We also looked at one-year outcomes in those who had poor prognoses and found that they did worse, they had diminished change in disease activity scores,” Harrold explains.

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