Patients with rheumatoid arthritis and a high multibiomarker disease activity (MBDA) score were more likely than were patients with low scores to add or switch to biologics or JAK inhibitors, according to a study on the uptake and influence of MBDA testing among rheumatologists and patients.
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Dr. Jeffrey R. Curtis
“While we cannot provide certainty that the main reason that clinicians switched therapies was the MBDA test result, we note that the median time to add or switch to a new RA treatment was 1-2 months after testing, lending plausibility to the MBDA test being influential in this decision,” wrote Jeffrey R. Curtis, MD, of the division of clinical immunology and rheumatology at the University of Alabama at Birmingham, and his coauthors. Their report is in The Journal of Rheumatology.
The researchers analyzed Medicare data from 60,596 RA patients who had taken at least one MBDA (Vectra DA) test. Patients with high MBDA scores who were not taking biologics or a JAK inhibitor were most likely to begin one of the two treatments, at 19.7%, compared with 11.8% for a moderate MBDA score and 9.0% for a low score. For patients already receiving those treatments, the proportion adding or switching was 13.5% for high, 8.3% for moderate, and 5.2% for low MBDA scores. In addition, patients with high MBDA scores who added a new medication and saw no improvement in score were prone to see treatment fail; the likelihood of failure in that scenario was 61% higher (OR = 1.61; 95% confidence index, 1.27-2.03) than in patients whose score improved to low or moderate.
The authors acknowledged that their study did not randomize clinicians nor gather data as to why the tests were ordered, which made it “difficult to assess the incremental value of the information provided by testing above and beyond clinical measurement, or to know whether the treatment changes were appropriate.” However, they also noted the MBDA score’s value as a complement to clinical assessment and an indicator of disease activity, suggesting “ongoing clinical trials and forthcoming data (e.g., MBDA to refine the patient-specific predicted risk of future radiographic damage) will be useful to further define the optimal role for the MBDA test in clinical practice to optimize longer-term outcomes.”
The study was partly supported by Myriad Genetics, which owns Crescendo Bioscience, the company that markets the MBDA test known as Vectra DA. Dr. Curtis receives support from the National Institutes of Health and the Patient-Centered Outcomes Research Institute, along with research grants and/or consulting fees from Amgen, Bristol-Myers Squibb, Corrona, Janssen, Myriad Genetics, Pfizer, and UCB. One coauthor reported receiving support from the NIH and research grants from Pfizer.
SOURCE: Curtis JR et al. J Rheumatol. 2018 Nov 15. doi: 10.3899/jrheum.180071.