Different Definitions Of Remission Research Articles

Concordance and Discordance Between Patient-reported Remission, Patient-reported Outcomes, and Physician Global Assessment.

Although validated patient-reported outcome (PRO) measurements can categorize patients with inflammatory bowel disease (IBD) into clinical remission or active disease, patients may have different definitions of remission. The purpose of this study was to compare patient-defined remission to remission based on PRO measures and physician global assessment (PGA) and to understand the clinical and demographic factors associated with disagreements. We retrospectively analyzed 3257 de-identified surveys from 2004 IBD patients who consented to participate in the Crohn's and Colitis Foundation's IBD Qorus Learning Health System between September 2019 and February 2021. We used logistic regression models with generalized estimating equations to analyze the clinical and demographic factors (eg, age, disease duration, health confidence) associated with discordance between patient-defined remission (yes/no) and PRO-defined remission for ulcerative colitis (UC; PRO2: stool frequency, rectal bleeding) and Crohn's disease (CD; PRO-3: average number of liquid stools, abdominal pain, well-being). Among patients with UC, overall concordance was 79% between patient self-report and PRO2-defined remission and 49% between patient self-report and PGA-defined remission. Among patients with CD, overall concordance was 69% between patient self-report and PRO3-defined remission and 54% between patient self-report and PGA-defined remission. Patients in PRO-defined remission were more likely to report active disease if they had IBD <5 years and low health confidence. Patients with PRO-defined active disease were more likely to report remission if they were not using prednisone and had high health confidence. Discordance exists between how remission is defined by patients, PRO measures, and PGA.

Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

ObjectiveTo determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual.MethodsPatients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were...

CONCORDANCE BETWEEN REMISSION DEFINED BY PATIENTS VS PATIENT-REPORTED OUTCOME MEASURES IN INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Although validated patient-reported outcome measurements (PRO) can categorize patients with inflammatory bowel disease (IBD) into remission or active disease, patients may have different definitions of remission. Patients may assume a new normal with altered bowel habits/abdominal pain after diagnosis or consider themselves to have active disease even though disease activity measures show remission. We aim to examine concordance between patient-defined remission and remission based on PRO-2 (ulcerative colitis; UC) or PRO-3 (Crohn’s disease; CD), and associations with demographic and disease-related factors. METHODS We retrospectively analyzed 3257 de-identified surveys from 2004 unique patients (806 UC; 1198 CD) who consented to participate in the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System. Surveys were collected at IBD clinic visits between September 2019 and February 2021. We used logistic regression models with generalized estimating equations to analyze the sensitivity, specificity, concordance, and discordance between patient-defined remission (yes/no) and PRO-defined remission (PRO-2: stool frequency, rectal bleeding; PRO-3: stool frequency, abdominal pain, wellbeing). We also examined steroid-free PRO remission (PRO-defined remission plus absence of steroids). RESULTS In CD, 63.3% of patients with inactive disease based on PRO-3 considered themselves in remission (adjusted sens=0.62). Discordance was more common among patients with &amp;lt;5 years disease duration (OR 1.6), and those who used prednisone (OR 4.2) or opioids (OR 5.3). Among patients with active disease based on PRO-3, 20.8% considered themselves in remission (adjusted spec=0.79) and discordance was more common with long disease duration (&amp;gt;15 years; OR 2.6) and those who did not use prednisone (OR 3.0) and opioids (OR 5.4). In UC, 77% of patients with inactive disease based on PRO-2 considered themselves in remission (adjusted sens=0.77). Discordance was more common among patients with disease duration of &amp;lt;5 years compared to those &amp;gt;15 years (OR 2.3). Among patients with active disease based on PRO-2, 19.2% considered themselves in remission (adjusted spec=0.79) and discordance was more common in patients who did not use prednisone (OR: 2.2). Age and gender were not associated with discordance. Results were similar with steroid-free PRO defined remission (Table 2). CONCLUSION Discordance between how patients and PRO measures define remission is common. Patients with shorter disease duration were more likely to report active disease when they were in remission while patients with longer disease duration were more likely to report remission while they still experienced symptoms. 1 in 3 (32%) assessments of disease remission were discordance among patients with CD, and 1 in 4 (22%) in patients with UC.

CONCORDANCE BETWEEN REMISSION DEFINED BY PATIENTS VS PATIENT-REPORTED OUTCOME MEASURES IN INFLAMMATORY BOWEL DISEASE

Although validated patient-reported outcome measurements (PRO) can categorize patients with inflammatory bowel disease (IBD) into remission or active disease, patients may have different definitions of remission. Patients may assume a new normal with altered bowel habits/abdominal pain after diagnosis or consider themselves to have active disease even though disease activity measures show remission. We aim to examine concordance between patient-defined remission and remission based on PRO-2 (ulcerative colitis; UC) or PRO-3 (Crohn’s disease; CD), and associations with demographic and disease-related factors.

P475 Real world data on treatment success and drug persistence in anti-TNF therapy for ulcerative colitis

Abstract Background The efficacy and safety of anti-TNF treatment for ulcerative colitis (UC) have been well documented in clinical trials. More data are required to increase knowledge on treatment success in a real world setting. This study reports real world data on treatment success, drug persistence and safety of anti-TNF treatment in patients with UC. Methods Patients with UC starting anti-TNF treatment with infliximab (IFX) or adalimumab (ADA) between January 2014 and December 2019 at Oslo University Hospital in Norway were included in a retrospective review of medical records. Eligible patients were biologically naïve adults (≥18 years) with no history of UC-related surgery. Follow-up was 12 months. Drug persistence was defined as the proportion of patients still receiving first-line anti-TNF treatment without addition of a second biologic agent. Remission was defined as i) clinical remission (six-point Mayo Score &amp;lt;2), ii) biochemical remission (fecal calprotectin &amp;lt;250 and CRP &amp;lt;5) or iii) a combination of the two. Treatment success was defined as drug persistence and remission. Serious adverse events (SAEs) were defined according to Good Clinical Practice guidelines. Results In total, 116 patients were included (mean age 35.5 ±13.9 years (SD), 58% male), of which 95 received IFX treatment and 21 ADA. Drug persistence was 74%. Treatment success by different definitions of remission and remission rates for drug persistent patients according to these definitions are reported in the table. SAEs were recorded on 18 occasions (four immediate infusion reactions, two colectomies, five infections and seven other events). Conclusion Treatment success by the strictest definition of remission was 40%. Of drug persistent patients, 44% were not in remission when applying the same definition. Whether these results reflect inadequacies in definitions of remission, a tendency for clinicians to let other variables guide treatment or a delay in drug switching warrants further investigation.

Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients

ObjectivesTo determine the impact of excluding patient global assessment (PGA) from the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission criteria, on prediction of radiographic and functional...

THU0096 REVISITING THE REMISSION CRITERIA FOR RHEUMATOID ARTHRITIS BY EXCLUDING PATIENT GLOBAL ASSESSMENT: AN INDIVIDUAL PATIENT META-ANALYSIS INCLUDING 5792 PATIENTS

Background:Remission nowadays is the guiding target of management of rheumatoid arthritis (RA). However, no gold standard definition of remission exists and the inclusion of patient global assessment (PGA) in remission definitions is debated (1).Objectives:To determine the impact of excluding PGA from the ACR/EULAR Boolean remission criteria, upon prediction of radiographic outcome of RA.Methods:Meta-analyses using individual patient data from randomized controlled trials (identified through PubMed and Clinicaltrials.gov until 2017) testing the efficacy of biological agents on radiographic outcomes at ≥2 years. Remission was defined using the ACR/EULAR remission criteria with 4 variables (Figure 1): (i) tender and swollen 28-joint counts (TJC28/SJC28), C-reactive protein (CRP, mg/dl), and PGA (0-10=worst) all ≤1 (4V-remission), (ii) the same, except PGA&gt;1 (4V-near-remission) (iii) 3V-remission (similar to 4V, but without PGA, i.e. equal to the combination of i and ii), and (iv) non-remission (TJC28 and/or SJC28 and/or CRP &gt;1). Meta-analyses were performed using the DerSimonian-Laird random-effects method. Good radiographic outcome (GRO) was defined as an increase of ≤0.5 modified Total Sharp score (mTSS) units. The relationship between the most stringent remission class achieved at 6 or 12 months and GRO during the second year was analysed. The pooled probabilities of GRO for the different definitions of remission were estimated and compared.Results:Individual patient data (n=5,792) from eleven trials were analysed. 4V-remission was achieved by 23% of patients (95%CI: 18-28%) and 4V-near-remission by 19% (95%CI: 15-22%) and thus, 3v-remission by 42% (95%CI: 36-48%). The probability of GRO in the 4V-near-remission group was similar to that of 4V-remission (78 vs 81%, ns) and significantly higher than that for non-remission (72%; difference 6%; 95%CI: 2-10%) (Table 1). These results were confirmed by meta-analyses of odds ratios of obtaining GRO of these groups (Graph 1). 3V-remission showed a higher predictive value for GRO (51%, 95%CI: 47-55%) than 4V-remission (41%, 95%CI: 35-46%) (Figure 2).Table 1.Pooled outcomes and measures of association between remission categories and good radiographic outcome (GRO, defined as ΔmTSS≤0.5), during the second year of follow-up.Groups4V-remission(n=1,378)4V-near-remission(n=1,085)Non-remission(n=3,329)Percentage GRO (95%CI)81 (74 to 87)78 (70 to 86)72 (62 to 81)Comparisons4V-near-remission vs4V-near-remission vs4V-remissionNon-remissionΔ percentage GRO (95%CI)−2.9 (−7.3 to 1.5)6.2 (2.3 to 10.1)Conclusion:4V-near-remission and the original 4V-remission are similarly predictive of GRO, therefore combining these in the 3V-remission definition potentially reduces the risk of overtreatment compared to the 4V definition. This supports the use of 3V-remission as the target for immunosuppressive therapy. The patient’s perspective, which must remain central, requires a separate treatment aim: a dual-target approach.

Variability in remission in family therapy for anorexia nervosa.

The evolution toward more stringent conceptualizations of remission in family therapy for adolescent anorexia nervosa (AN) has, with time, introduced variability in outcomes across randomized controlled trials (RCTs). An examination of remission across the history of research on family therapy for AN shows that earlier studies adopted lenient definitions and generally yielded higher rates of remission than studies of the past decade that have used stricter definitions of remission. In this study, we investigate the reactivity of remission rates to the application of different definitions of remission used within the family therapy for AN literature, within a single RCT data set. We conducted a secondary analysis of data from a single-site RCT which compared the relative efficacy of two formats of family therapy in a sample of 106 Australian adolescents with AN. Using end-of-treatment data, we compared remission rates using 11 definitions of remission that have been used in studies of family therapy for AN spanning more than three decades. We found wide variability in remission rates (21.7-87.7%; Cochran's Q χ2 (10, N = 106) = 303.55, p = .000], depending on which definition of remission was applied. As expected, more lenient criteria produced higher remission rates than more stringent definitions. Applying different criteria of remission to a single data set illustrates the impact of changing how remission is defined. Failure to consider the greater stringency of remission criteria in recent studies could result in false inferences concerning the efficacy of family therapy for AN over time.

Clinical deep remission and related factors in a large cohort of patients with rheumatoid arthritis.

Background:Clinical remission is the treatment target in rheumatoid arthritis (RA). This study aimed to investigate clinical remission and related factors in a large cohort of patients with RA.Methods:This study composed of 342 patients with RA. Data were collected by face-to-face interview of 1049 patients with RA who visited the Department of Rheumatology of three teaching hospitals from September 2015 to May 2016. The patients with RA were clinically assessed by rheumatologists and a four-page questionnaire was completed on site. Subsequently, patients fulfilled remission criteria were further analyzed. The practicability of different definitions of remission of RA was rated by a panel of rheumatologists. Sustained intensive disease modifying anti-rheumatic drug (DMARD) treatment was defined as a combination treatment with two or more DMARDs for at least 6 months.Results:In this cohort of 342 patients with RA, the proportions of patients achieving remission were 38.0%, 29.5%, 24.9%, 21.1%, 19.0%, 18.1%, and 17.0%, based on criteria of disease activity score in 28 joints (DAS28) using CRP (DAS28-CRP), DAS28 using ESR (DAS28-ESR), routine assessment of patient index data 3 (RAPID-3), Boolean, simplified disease activity index (SDAI), clinical disease activity index, and the newly described clinical deep remission (CliDR), respectively. Boolean and CliDR are the best in practicability scored by rheumatologists (7.5 and 8.0, respectively). Compared with the non-sustained intensive group, sustained intensive treatment with DMARDs yielded higher remission rates of 25.6%, 23.8%, and 21.3% in patients with RA based on Boolean (χ2 = 3.937, P = 0.047), SDAI (χ2 = 4.666, P = 0.031), and CliDR criteria (χ2 = 4.297, P = 0.038). The most commonly prescribed conventional synthesized DMARDs (csDMARDs) in patients with RA was leflunomide, followed by methotrexate, and hydroxychloroquine. Compared with the non-remission group, patients achieving remission had a longer median duration of DMARDs (45.0 [22.8–72.3] months, Z = −2.295, P = 0.022).Conclusions:The findings in this study indicated that clinical deep remission is achievable in patients with RA. Sustained intensive DMARD treatment is needed to achieve a better outcome in RA.

Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries

BackgroundThe objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients’ and physicians’ perspectives.MethodsIn ReFlap (Remission/Flare in...

A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS)

ObjectivesTreat-to-target recommendations have identified ‘remission’ as a target in systemic lupus erythematosus (SLE), but recognise that there is no universally accepted definition for this. Therefore, we initiated a process to...

Remission is related to CRP and smoking in early axial spondyloarthritis. The DESIR cohort

IntroductionNo evaluation of factors associated with remission has been performed in early SpA. The aim of the study was to evaluate percentage of patients in remission using and comparing different definitions of remission, and to evaluate factors associated with remission at inclusion in the prospective DESIR cohort, and after 24 months. MethodsPerformance of three definitions (ASAS partial remission [PR], ASDAS-CRP less than 1.3 [ASDAS-R], BASDAI less than 3.6 [BASDAI-R]) were assessed using sensibility, specificity and Youden Index. Data at M0 and M24 were analyzed in uni- and multivariate analysis. ResultsSeven hundred and six patients were evaluated at M0 and 577 at M24. At M0, percentage of patients in remission was 4% (PR), 8% (ASDAS), 34% (BASDAI), and at M24: 15%, 24% and 54% respectively, in the whole population and similar in Amor, ESSG and ASAS classified patients. BASDAI less than 3.6 had the best sensitivity, and ASDAS-R the best Youden index when using each of the two other definitions of remission as a gold standard. At M24 in multivariate analysis, remission was associated with less smoking, less analgesics, ASAS clinical arm fulfilling, less NSAIDs (ASDAS-R), low CRP (ASDAS-R), low BMI (BASDAI-R). However, over the two years, this study did not allow to demonstrate a relation between remission and structural progression or morbidity. ConclusionIn this population suggestive of early SpA, smoking and CRP appear as major markers of disease activity in early SpA, and associated with absence of remission.

Moving goal posts: Definition of diabetes remission after bariatric surgery

The escalating twin pandemics of obesity and type 2 diabetes mellitus (T2DM) present a major global public health burden. Bariatric surgery is an effective treatment for obese patients with T2DM, as it not only causes weight loss, but also improves metabolic risk factors including glycemia, hypertension and dyslipidemia. Although several studies have shown impressive remission rates of T2DM following bariatric surgery, these studies have used different definitions of remission. In an attempt to solve the problem of inconsistent definitions, the American Diabetes Association and International Diabetes Federation, two large diabetes organizations, have developed standardized criteria for T2DM remission. These criteria are comprised of clinical parameters including glucose, lipid and blood pressure control and medication usage. Studies using these criteria have reported lower rates of remission than those previously reported using nonstandardized definitions. This review describes the existing literature on remission of T2DM following bariatric surgery, and emphasizes the importance of using the standardized definitions established in order to improve remission rates and thus reduce the incidence of the macrovascular and microvascular complications of T2DM.

Remission of rheumatoid arthritis and potential determinants: a national multi-center cross-sectional survey.

The aim of this study is to investigate the remission rate of rheumatoid arthritis (RA) in China and identify its potential determinants. A multi-center cross-sectional study was conducted from July 2009 to January 2012. Data were collected by face-to-face interviews of the rheumatology outpatients in 28 tertiary hospitals in China. The remission rates were calculated in 486 RA patients according to different definitions of remission: the Disease Activity Score in 28 joints (DAS28), the Simplified Disease Activity Index (SDAI), the Clinical Disease Activity Index (CDAI), and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definition. Potential determinants of RA remission were assessed by univariate and multivariate analyses. The remission rates of RA from this multi-center cohort were 8.6% (DAS28), 8.4% (SDAI), 8.2% (CDAI), and 6.8% (Boolean), respectively. Favorable factors associated with remission were: low Health Assessment Questionnaire (HAQ) score, absence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), and treatment of methotrexate (MTX) and hydroxychloroquine (HCQ). Younger age was also predictive for the DAS28 and the Boolean remission. Multivariate analyses revealed a low HAQ score, the absence of anti-CCP, and the treatment with HCQ as independent determinants of remission. The clinical remission rate of RA patients was low in China. A low HAQ score, the absence of anti-CCP, and HCQ were significant independent determinants for RA remission.

Effect of Remission Definition on Healthcare Cost Savings Estimates for Patients with Rheumatoid Arthritis Treated with Biologic Therapies

Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.

AB0377 Clinical, Functional, and Structural Consequences of Targeting Low Disease Activity Rather than Remission in Early and Established Rheumatoid Arthritis Using Methotrexate or Methotrexate plus Adalimumab

BackgroundRheumatoid arthritis (RA) treat to target (tgt) recommendations advocate clinical remission (REM) as the tgt; targeting low disease activity (LDA) is an alternative for patients (pts) who cannot attain REM....

PReS-FINAL-2003: Remission and predictors of persistent disease activity at 30 years follow-up in a Norwegian cohort of juvenile idiopathic arthritis patients

Long-term studies of remission rates in juvenile idiopathic arthritis (JIA) are few and difficult to compare because of different definitions of remission.

Physician global assessment at 3 months is strongly predictive of remission at 12 months in early rheumatoid arthritis: results from the CATCH cohort

The objective of this study was to determine predictors of 1-year remission in early RA (ERA) using baseline and 3-month data. The Canadian Early Arthritis Cohort (CATCH) patients were included if baseline, 3- and 12-month data were available. Regression analyses for four different definitions of remission at 12 months were done to determine baseline and 3-month predictors of remission. Five hundred and sixty-two patients had complete data at 12 months (mean age 53.4 years, disease duration 6.2 years, 73% female). The factors at baseline associated with all four remission outcomes at 12 months were age, gender, income, education, tender joint count (TJC), patient global assessment (PtGA), HAQ and pain. Baseline ESR was associated with the 28-joint DAS (DAS28) remission only. At 3 months, all four remission definitions were associated with TJC, swollen joint count, physician global assessment (PGA), PtGA, HAQ, pain, ESR and CRP in univariate analyses. In the regression model, variables associated with Simple Disease Activity Index remission were PGA [odds ratio (OR) 0.77, P < 0.001), pain (OR 0.85, P = 0.004), age (OR 0.98, P = 0.006) and HAQ (OR 0.49, P = 0.011); Clinical Disease Activity Index remission was associated with PGA (OR 0.77, P < 0.001), pain (OR 0.85, P = 0.003), age (OR 0.98, P = 0.015) and CRP (OR 0.80, P = 0.031). DAS28 remission was predicted by ESR (OR 0.95, P < 0.001), PGA (OR 0.76, P < 0.001), age (OR 0.98, P = 0.001), HAQ (OR 0.57, P = 0.006) and male gender (OR 2.01, P = 0.005), whereas Boolean remission was associated with pain (OR 0.79, P = 0.009), age (OR 0.98, P = 0.016), PtGA (OR 0.83, P = 0.025) and PGA (OR 0.86, P = 0.038). A low PGA at 3 months was consistently associated with 1-year remission in ERA.

FRI0050 Physician global assessment at three months is strongly predictive of disease activity at 12 months in early rheumatoid arthritis. results from the catch cohort.

BackgroundIdeally more patients with early rheumatoid arthritis (ERA) will obtain remission if we can predict very early in their disease course (such as by 3 months) who will be in...

SP0188 Structural progression in RA remission: Can MRI predict it?

Remission has become in the last few years an accessible objective in the management of rheumatoid arthritis (RA) patients due to treatment improvement and the development of international guidelines. The...