Patient-reported outcomes as early warning signs of flare following drug cessation in rheumatoid arthritis
Authors' conclusion
Our data support the potential value of remote PRO monitoring of RA patients in drug-free remission to identify flare occurrence.
Study context
- Population
- Rheumatoid arthritis (RA) patients in sustained remission after conventional synthetic disease-modifying antirheumatic drug (csDMARD) cessation (BIO-FLARE cohort)70.1% females
- Participants
- 121 patients
- Exposure
- Changes in four PROs as predictors of flare after csDMARD cessation
- Outcome
- Flare (DAS28-CRP ≥3.2 at any visit, DAS28-CRP ≥2.4 on two visits within 2 weeks, or resuming DMARD and/or steroid therapy despite DAS28-CRP <2.4)
- Follow-up
- 6-month follow-up
Methodological detailsCox regression with time-varying covariates, ROC curve analysis
- Cox regression with time-varying covariates
- ROC curve analysis
Main finding
As reported in the abstract
Flare detection by PRO change
| Group | AUC | PPV (increment ≥5.5 from baseline) | NPV (increment ≥5.5 from baseline) |
|---|---|---|---|
| FLARE-RA | 0.90 (95% CI 0.84 to 0.96; p=0.001) | — not stated in the abstract | — not stated in the abstract |
| RA Flare Questionnaire (RA-FQ) | 0.90 (95% CI 0.84 to 0.96; p=0.001) | 80% | 91% |
AUC
FLARE-RA0.90 (95% CI 0.84 to 0.96; p=0.001)
RA Flare Questionnaire (RA-FQ)0.90 (95% CI 0.84 to 0.96; p=0.001)
PPV (increment ≥5.5 from baseline)
FLARE-RA— not stated in the abstract
RA Flare Questionnaire (RA-FQ)80%
NPV (increment ≥5.5 from baseline)
FLARE-RA— not stated in the abstract
RA Flare Questionnaire (RA-FQ)91%
— not stated in the abstract
- Flare occurred
- 58/121 (47.9%)
- 1-point change in each PRO score strongly associated with flare (multivariate Cox regression)
- P < 0.001 in each case
Observational data: associations, not effects.
Original publication
Patient-reported outcomes as early warning signs of flare following drug cessation in rheumatoid arthritis. RMD Open. Published 1 April 2025. doi:10.
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