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Can a rheumatoid test predict serious infection and MI? Surprises from VECTRA test.
November 14 2016 12:55 PM ET — via RheumReports
Curtis J et al (Abstract #1492) looked at more than 77,000 multi-biomarker disease activity (MBDA; VECTRA) tests in RA patients in a US Medicare Claims database. After the test was done with a lag time of at least a couple of weeks, a high MBDA score predicted serious infection and myocardial infarctions (MIs).
The RA population was older than many studies (mean age 69 [SD 10] years) as it is a Medicare population, 79% were women, and 80% white. RA therapies included biologics (20%), MTX (half), other non- biologic DMARDs (40%), but half were receiving steroids – so this population is not generalizable to many of our usual patients.
However, using MBDA with or without the CRP component and censoring to tests ordered that could have been related to inflammation at the time of sepsis or MI, the MBDA score was more predictive of these important future events in a dose response fashion (high, medium, low).
What are the take homes:
I am shocked at how many MBDA tests have been ordered over 3 years!
Some kidding aside this is an interesting use of the test to accurately predict future bad outcomes.
We don't know if clinical parameters such as CDAI would be as predictive.
We don't know why the test was ordered.
These are not the usual patients as so many were on steroids and fewer on biologics compared to the US RA population with a penetration of 1 in 3 to 1 in 2. So there may be confounding by indication (no biologic as 'too' sick so steroids were used) and this is a highly at-risk group for serious infection and MIs.
So, sorry no take home messages yet but very interesting data.
As an aside, a poster by GS Kerr, et al. from Nebraska (Abstract #487) studied clinically active RA patients with normal acute phase reactants (the kind of patients we often see). Nearly 1500 patients are in their cohort (also more males which implies to me that a VA hospital is part of the study group). They found that MBDA (VECTRA) was also not associated with clinically active but normal ESR/CRP patients, and thus was unhelpful.
So, if you think a patient has active disease, a lab test won't help in general, so we have to continue with our old-fashioned physical exam.
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About the Author
Dr. Janet Pope
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.
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