Breaking News
January 17, 2018 - Bariatric surgery extends lifespan in obese patients, shows study
January 17, 2018 - Bristol-Myers Squibb Receives FDA Approval for Opdivo (nivolumab) as Adjuvant Therapy in Patients with Completely Resected Melanoma with Lymph Node Involvement or Metastatic Disease
January 17, 2018 - Ewww Moments in the ER: That’s Improbable!
January 17, 2018 - Booze may help or harm the heart, but income matters
January 17, 2018 - Top nutrients needed to boost mood and energy levels on Blue Monday
January 17, 2018 - Scientists develop unique technique to map elasticity of cell components
January 17, 2018 - Obesity surgery reduces the risk of death by half finds new study
January 17, 2018 - Raw Meat Not the Safest Choice for Your Dog or for You
January 17, 2018 - Men who lack HSD17B4 gene may be more susceptible to treatment-resistant prostate cancer
January 17, 2018 - High-Dose Aspirin Preferred for Kawasaki’s
January 17, 2018 - Study suggests risk management approach to combat EMS fatigue
January 17, 2018 - A new therapy against obesity
January 17, 2018 - Doctors warn against holding your nose and closing your mouth to contain a sneeze
January 17, 2018 - Measles outbreak alarms public health officials
January 17, 2018 - FDA Slaps Class Warning on Gadolinium Contrast Agents
January 17, 2018 - Distinct human mutations can alter the effect of medicine
January 17, 2018 - ASIT biotech’s new article presents clinical results of gp
January 17, 2018 - Alternative tobacco use by adolescents associated with greater odds of future cigarette smoking
January 17, 2018 - A High-Salt Diet Produces Dementia In Mice
January 17, 2018 - Scientists provide insights into crucial interaction for DNA repair
January 17, 2018 - Sanofi and Regeneron Announce Positive Topline Pivotal Results for PD-1 Antibody Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma
January 17, 2018 - Morning Break: Pfizer Kills AD/PD Pipeline; Trump Affirms His Mental Health; Humira Pricing Strategy
January 17, 2018 - Researchers see gene influencing performance of sleep-deprived people
January 17, 2018 - Fast food triggers the immune system making it hyperactive
January 17, 2018 - Scientists find increased risk of HIV outbreaks in Ukraine due to war-related migration
January 17, 2018 - New universal flu vaccine moves to clinical trial phase and could be a reality soon
January 17, 2018 - Cocaine de-addiction breakthrough shows promise
January 17, 2018 - FDA Accepts New Drug Application for Seysara (sarecycline) for the Treatment of Moderate to Severe Acne
January 17, 2018 - Robotic Telestenting; BP Cuff Smartwatch; Medicare Bundled Care
January 17, 2018 - New cellular approach found to control progression of chronic kidney disease
January 17, 2018 - Lamprey genes provide clues to repair spinal cord damage, finds study
January 17, 2018 - Tissue-based soft robot could lead to advances in bio-inspired robotics
January 17, 2018 - Mostly the healthy and wealthy Americans use mobile phone apps to track sleep habits
January 17, 2018 - FDA Alert: Varubi (rolapitant) Injectable Emulsion: Health Care Provider Letter
January 16, 2018 - NeuroBreak: Rough Days for Neuroscience Research; Another Migraine Drug Advances
January 16, 2018 - The ‘greatest pandemic in history’ was 100 years ago – but many of us still get the basic facts wrong
January 16, 2018 - Serena Williams Shares Childbirth Ordeal
January 16, 2018 - The Artificial Brain as Doctor
January 16, 2018 - Type 2 diabetes has hepatic origins
January 16, 2018 - Expert discusses how to identify, support individuals with drug or alcohol addiction in workplace
January 16, 2018 - Starting menstruation early increases risk of cardiovascular disease and stroke in later life
January 16, 2018 - CapsoVision receives CE Mark approval for use of CapsoCam Plus System in pediatric patients
January 16, 2018 - Researchers develop new dynamic statistical model to follow gene expressions over time
January 16, 2018 - Alzheimer’s ‘looks like me, it looks like you’
January 16, 2018 - By the Numbers: Physicians’ Economic Impact
January 16, 2018 - Sound Health | NIH News in Health
January 16, 2018 - Modifying baby formula doesn’t prevent type 1 diabetes in children
January 16, 2018 - Energy drinks dangerous for kids
January 16, 2018 - When you need a breast screening, should you get a 3-D mammogram?
January 16, 2018 - Johns Hopkins gets approval to perform HIV positive to HIV positive living donor kidney transplants
January 16, 2018 - The Salk Institute and Indivumed collaborate for cutting-edge cancer research
January 16, 2018 - Study reveals negative long-term effects of heavy cannabis use on brain function and behavior
January 16, 2018 - Many gym-goers injure themselves by pushing harder to be better than friends
January 16, 2018 - Risankizumab Meets All Primary Endpoints Reporting Positive Results in Fourth Pivotal Phase 3 Psoriasis Study
January 16, 2018 - Federal Junk Food Tax Feasible, Study Says
January 16, 2018 - Do girls have stronger teeth than boys?
January 16, 2018 - New high-sensitivity blood tests could aid faster diagnosis and treatment for heart attack
January 16, 2018 - How fatal mitochondrial diseases may strike offspring of families with no history of the conditions
January 16, 2018 - TherapeuticsMD Announces FDA Acceptance of New Drug Application and Prescription Drug User Fee Act (PDUFA) Date for TX-004HR
January 16, 2018 - Morning Break: Food Pharmacies; Obamacare Sign-ups Dip; Top Pot Studies
January 16, 2018 - Blood pressure declines 14 to 18 years before death
January 16, 2018 - ViLim Ball technology helps reduce uncontrollable shaking hands
January 16, 2018 - Researchers use immune-mimicking biomaterial scaffolds to fast track T cell therapies
January 16, 2018 - In Wisconsin, hopes rise for production of a lifesaving radioactive isotope
January 16, 2018 - Researchers develop software to better predict risk of leakage around aortic stents
January 16, 2018 - Bile acids could directly burn away lipids in the fat depots
January 16, 2018 - Cycling does not negatively impact sexual and urinary health finds study
January 16, 2018 - Severe peer victimization in childhood may contribute to mental health issues in adolescence
January 16, 2018 - Exelixis Announces U.S. FDA Approval of Cabometyx (cabozantinib) Tablets for Previously Untreated Advanced Renal Cell Carcinoma
January 16, 2018 - Just How Often Do Patients Turn Post-Surgical Opioids Into a Habit?
January 16, 2018 - Opioid addiction – Genetics Home Reference
January 16, 2018 - Incomplete revascularization in PCI linked to higher mortality
January 16, 2018 - Machine learning algorithm uses brain scans to predict language ability in deaf children
January 16, 2018 - Penn scientists identify new therapeutic target for treatment of melanoma
January 16, 2018 - The London Clinic exhibits innovative technology to treat Parkinson’s disease at Arab Health
January 16, 2018 - Early influenza testing is critical to prevent serious complications
January 16, 2018 - Study Gets to the Core of Back Pain in Runners
January 16, 2018 - Year in Review: Ophthalmology | Medpage Today
January 16, 2018 - ClinicalTrials.gov: Marijuana Use
January 16, 2018 - Researchers create novel compound targeting melanoma cells
RA Biomarker Panel IDs Patients at High Risk for Cardiovascular Events

RA Biomarker Panel IDs Patients at High Risk for Cardiovascular Events

image_pdfDownload PDFimage_print

Action Points

  • Higher rheumatoid arthritis (RA) disease activity, as measured by a multi-biomarker disease activity (MBDA) panel of biomarkers, was associated with higher rates of hospitalized infections, myocardial infarction (MI), and coronary heart disease (CHD) events.
  • The 100-point MBDA system, based on a set of 12 protein biomarkers, has been shown to correlate well with disease activity in several RA cohorts, and is commercially available from Crescendo Biosciences under the name Vectra DA.

Higher rheumatoid arthritis (RA) disease activity, as measured by a multi-biomarker disease activity (MBDA) panel, was associated with higher rates of hospitalized infections, myocardial infarction (MI), and coronary heart disease (CHD) events, analysis of Medicare data indicated.

Higher MBDA test scores were associated with increased serious infection events (HR 1.32 per 10-unit score increment, 95% CI 1.23-1.41), Jeffrey R. Curtis, MD, MPH, of the University of Alabama at Birmingham and colleagues reported.

Scores higher than 30 also were associated with increased MI (HR 1.52, 95% CI 0.92-2.49) and CHD rates (HR 1.54, 95% CI 1.01-2.34), compared with scores less than 30.

“In this large RA population predominantly consisting of older individuals, higher MBDA scores were associated with increased risk for hospitalized infection, MI and CHD events,” they wrote in Annals of the Rheumatic Diseases.

“A strong dose–response gradient existed between MBDA scores and hospitalized infections (pneumonia and sepsis). The patterns for MI and CHD events suggested more of a threshold effect, where those with the lowest level of disease activity and inflammation were at lowest risk, but gradations with higher levels of the biomarker were relatively absent,” they added.

The 100-point MBDA system is based on a set of 12 protein biomarkers, shown to correlate well with disease activity in several RA cohorts. It is commercially available from Crescendo Biosciences under the name Vectra DA. A score under 30 is considered low, 30–44 moderate, and over 44 high.

For this analysis, the researchers used national Medicare fee-for-service claims from 2010 to 2014, linking that information to patient-specific MBDA scores supplied by Crescendo.

To be included in the study, a patient needed to have at least one valid MBDA score linked to Medicare claims and at least 365 continuous days of Medicare with Part D coverage before the first valid MBDA test date.

The researchers excluded patients who had an International Classification of Diseases (ICD)-9 diagnosis code for ankylosing spondylitis, inflammatory bowel disease psoriasis, psoriatic arthritis, systemic lupus erythematosus, malignancy (except non-melanoma skin cancer), polymyalgia rheumatica, and giant cell arteritis in the 12-month baseline period. They also excluded patients who had initiated any non-tumor necrosis factor biologic or synthetic targeted disease-modifying anti-rheumatic drugs (DMARDs) in the 183 days before the index date.

Patients who had a prior MI, coronary artery bypass grafting, or percutaneous coronary intervention were not included in the MI and CHD outcome.

Because MBDA scores could be affected by an evolving outpatient infection or MI, the researchers also excluded patients from the MI and CHD analysis if they had heart attacks or coronary events in the 7 days following the MBDA test. Similarly, they excluded patients from the serious infection outcome if they had a serious infection in the 14 days after the test.

A total of 17,433 patients were eligible for the serious infection analysis and 16,796 patients for the MI and CHD outcome. Overall, the average age was 69 years; 79% were women, 81% were white, and 38% were disabled. These patients used methotrexate (54%), oral glucocorticoids (53%), non-biologic DMARDs (40%) and biologics (17%) to treat their RA.

Characteristics of patients in lower MBDA categories suggested they were younger (a 3-year difference), had a lower burden of comorbidities, and used less glucocorticoids and more biologics than patients with higher MBDA scores.

After multivariable adjustment, higher MBDA scores were associated with statistically significantly higher rates of serious infection events and higher MI and CHD rates.

Because C-reactive protein, one of the MBDA biomarkers, might influence outcomes, the researchers performed sensitivity analyses excluding it and found similar results: a 1.5-fold (CHD) and 1.7-fold (MI) elevated risk for patients in the higher disease activity category compared with the lowest.

“The current study is novel in that it leveraged a large administrative data source linked to a laboratory test provider database to address a question that neither data source by itself could address,” the authors wrote.

The results should be interpreted in light of the study design, they noted. It included predominantly older adults and findings might not apply to younger RA patients.

“However, given that the prevalence of infectious and CHD risk factors generally increases with age, we would speculate that the associations between RA disease activity and the outcomes that we studied might be even stronger in younger patients with RA,” they wrote.

This analysis was supported in part by Crescendo Bioscience, which is part of Myriad Genetics.

Curtis is a consultant for Myriad Genetics and has received research grants from them.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-04-01T00:00:00-0400

last updated

Tagged with:

About author

Related Articles