Vectra test superior to DAS28-CRP in predicting radiographic progression in RA
The Vectra multi-biomarker disease score, as determined by the Vectra molecular blood test, is a more successful predictor of radiographic progression in patients with rheumatoid arthritis than the DAS28-CRP or C-reactive protein, according to findings published in Current Medical Research & Opinion.
“In the area of personalized medicine, where more and more is being done to use information specific to the patient to provide them with treatments that will do the best possible job, the measurement of disease activity has emerged as a necessary and important part of monitoring RA patients,” Eric H. Sasso, MD, vice president of medical and scientific affairs at Crescendo Bioscience, a subsidiary of Vectra developer Myriad Genetics, told Healio Rheumatology.
“Previously, several studies have been published showing that the Vectra test is an effective predictor of a patient’s risk for radiographic progression, with evidence suggesting that it was better than the conventionally used measures, such as DAS28-CRP,” he added. “This paper represents the first time that these previous publications have ever been evaluated together in an approach similar to what one might call a meta-analysis.”
To compare the prognostic value of the multi-biomarker disease activity score to the DAS28-CRP and C-reactive protein regarding the risk for radiographic progression in patients with RA, Sasso and colleagues reviewed data from five cohorts in four studies, totaling 929 patients. All participants in the included studies had been diagnosed with RA and treated with conventional disease-modifying antirheumatic drugs either alone or in combination with adalimumab (Humira, AbbVie), infliximab (Remicade, Janssen) or abatacept (Orencia, Bristol Myers Squibb).
Radiographic progression rates during a 1-year period were determined for patients categorized according to whether the Vectra score was low, defined as less than 30 to 44; or high, defined as more than 44. The same was done with the DAS28-CRP and C-reactive protein measures. For DAS28-CRP, low was defined as 2.67 or less, moderate as greater than 2.67 through 4.09, and high as greater than 4.09. With C-reactive protein, 10 mg/L or less was defined as low, greater than 10 through 30 mg/L was moderate and greater than 30 mg/L was high. The researchers then determined positive and negative predictive value and relative risk for all “high” categories, compared with the others.
According to the researchers, radiographic progression was more frequent with increasing Vectra scores in each of the included studies. Positive predictive values were generally similar for Vectra, DAS28-CRP and CRP, although negative predictive values were greater for Vectra score, at 93% to 97%, than DAS28-CRP or C-reactive protein, at 77% to 87%. In addition, for three studies, relative risk scores for radiographic progression were greater when based on categories of Vectra score than on categories of DAS28-CRP or C-reactive protein, and the combined relative risk was approximately three times greater for Vectra scores (RR = 4.6) (P < .0001) than for DAS28-CRP (RR = 1.7) (P =.02) or C-reactive protein (RR = 1.7) (P =.002).
Among patients cross-classified by Vectra score and DAS28-CRP, high compared with not-high Vectra scores were significantly predictive of radiographic progression independently of the other measure.
“With this sort of information, it means that the practice and clinician can use Vectra tests to have a more accurate understanding of whether a treatment is working for a patient,” Sasso said. “This includes whether the treatment needs to be changed if it is not working, according to the Vectra test.” – by Jason Laday
Disclosure: Sasso reports employment with Crescendo Bioscience. Please see the study for all other relevant financial disclosures.