Multibiomarker disease activity test predicts radiographic progression, CV outcomes in RA
ATLANTA — A multibiomarker disease activity blood test predicted radiographic progression and cardiovascular outcomes in patients with rheumatoid arthritis, according to findings presented in two posters at ACR/ARP 2019.
“The research in these two abstracts, based on the Vectra test (Myriad Genetics), shows that the test can predict the future risk for irreversible joint damage and heart attack or stroke,” Jeff Curtis, MD, MPH, of the University of Alabama at Birmingham, told Healio Rheumatology in an interview. “The idea of being able to predict the future, in terms of radiographic progression in the first abstract and cardiovascular disease in the second, is a fantastic tool set for rheumatologists. We can tell our patients, ‘Rather than just feeling good for today, we can help figure out how to make you feel good for a lifetime.’”
In the first study, Curtis and colleagues evaluated the ability of the Vectra test to predict individual percentage risk of radiographic progression for 973 patients from four cohorts. The study population included 401 patients from the BRASS registry, 154 from the OPERA study, 235 patients from the SWEFOT study, and 163 patients from the Leiden registry.
Results indicated that the adjusted multibiomarker disease activity (MBDA) score bested DAS28-C-reactive protein (CRP) score, CRP, Clinical Disease Activity Index (CDAI), and swollen joint count in terms of prognosticating radiographic progression. In addition, MBDA was the most important predictor of those outcomes overall, according to pooled, univariate analysis results (P = 2.5 X 10-13).
Moreover, as the adjusted MBDA score increased, the risk for permanent joint damage also increased. For example, patients with a low adjusted MBDA score carried a 1% to 3% risk for radiographic progression in 1 year, while those with moderate- to high-MBDA scores were at a 7% to 47% risk for this outcome.
“We have never had a tool like this before,” Curtis said. “Heretofore, we have had no way of knowing what your risk of permanent joint damage might be.”
In the second study, Curtis and colleagues evaluated 30,751 Medicare patients from administrative data for the years 2006 to 2016. A composite outcome of myocardial infarction, stroke and cardiovascular death within 3 years served as the primary endpoint.
The researchers compared the MBDA score with four other cardiovascular outcome prediction models.
Baseline data showed that 39% of the cohort had diabetes, 78% had hypertension, 24% were smokers, and 37% had a high risk of a cardiovascular condition. Accordingly, the MBDA-based cardiovascular outcome score included age, diabetes, hypertension, smoking, history of high-risk CV conditions, the MBDA score, leptin, TNFRI and MMP-3, according to the results.
Results showed that the MBDA was superior to the other four models in predicting incidence of the primary outcome events.
Other findings indicated that when the MBDA cardiovascular score was converted to a 3-year percentage risk for a cardiovascular event, a moderate to high risk for such an event was observed in 80% of the cohort.
“This abstract relates to a patient’s future risk of a heart attack or stroke,” Curtis said. “We have never had a tool, certainly at the point of care, that is able to predict these outcomes in our patients.”
This is why the MBDA blood test, and its various potential uses, is so important, according to Curtis. “This test is the first of its kind to be able to predict outcomes in our patients,” he said. “It will help us have a discussion about getting patients rheumatoid arthritis under control overall.”
Curtis was unequivocal in his belief that the MBDA test is “ready for prime-time” use in daily rheumatology practice. However, ultimately, the decision is up to Myriad Diagnostics as to when to deploy this technology for widespread use.
“If there is one other thing to consider, it is that this test is not only helpful for clinicians, but it is also helpful to educate patients,” he said. “Vectra is sometimes used as a more objective measure of how a patient is doing. Patients know how they are feeling today, but understanding that a bad event may occur in the future helps facilitate communication, and helps the doctor and the patient make decisions to minimize risks going forward.” – by Rob Volansky
Curtis J. Abstract #466. Predicting risk of radiographic progression for patients with rheumatoid arthritis.
Abstract #2350. Derivation and validation of a biomarker-based cardiovascular risk prediction score in rheumatoid arthritis. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.
Disclosure: Curtis reports associations with Abbvie, Amgen, Bristol-Myers Squibb, Corrona, Crescendo, Lilly, Genentech, Janssen, Myriad, Pfizer, Radius Health, Regeneron, Roche and UCB.