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Rheumatology Advance Access published online on July 4, 2008
Rheumatology, doi:10.1093/rheumatology/ken233
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The importance of the baseline Disease Activity Score 28 in determining responders and non-responders to anti-TNF in UK clinical practice

N. Smith, T. Ding, S. Butt, K. Gadsby and C. Deighton

Department of Rheumatology, Derbyshire Royal Infirmary, Derby, UK.

Correspondence to: C. Deighton, Department of Rheumatology, Derbyshire Royal Infirmary, London Road, Derby, DE1 2QY, UK. E-mail: chris.deighton{at}derbyhospitals.nhs.uk


  Abstract

Objectives. The NICE re-appraisal of anti-TNF requires demonstration of ongoing response, making the baseline 28-joint Disease Activity Score (DAS28) crucially important. A retrospective analysis of all RA patients on their first anti-TNF determined predictive factors for those classified as non-responders at 6 months according to current NICE guidelines.

Methods. The patients were divided into responders (DAS28 dropped by >1.2) and non-responders. These groups were compared for demographics, DAS28 at the two pre-assessments 1 month apart and at baseline. Exposure to intramuscular, oral and IA steroids in the 3 months period before the baseline DAS28 was recorded.

Results. At 6-month assessment in 256 patients, 82.8% were responders with no demographic differences between them and non-responders. Although the first pre-assessment score was not significantly different (6.8 vs 6.6), the second pre-assessment score (7.1 vs 6.7) and the baseline DAS (7.2 vs 6.3) were lower in the non-responders (P < 0.04 and P < 0.001, respectively). Comparing the differences in DAS28 from the first pre-assessment to baseline, the responders had increased by 0.4, and the non-responders had decreased by 0.4, (P < 0.001). If the first pre-assessment score had been taken as the baseline DAS28, then 9.4% of responders would be re-classified as non-responders, and 31.8% of non-responders would be re-classified as responders. The proportion of patients who had steroid treatment within the 3 months period before the baseline DAS28 did not differ significantly between the responders and non-responders (34% vs 41%, P = 0.38).

Conclusion. Baseline DAS28 is critical in classifying responders at the 6-month assessment.

KEY WORDS: Rheumatoid arthritis, Anti-tumour necrosis factor therapies, Outcome measures, Baseline Disease Activity Score 28

Submitted 5 March 2008; revised version accepted 28 May 2008.
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