Michel Zummer

Université de Montréal, Montréal, Quebec, Canada

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Publications (64)292.35 Total impact


  • No preview · Conference Paper · Jul 2015

  • No preview · Conference Paper · Jul 2015
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    ABSTRACT: Background Recent studies have suggested that early and aggressive treatment of spondyloarthritis, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), may be associated with favorable patient outcomes, reducing synovial inflammation, delaying joint damage, and maintaining functional status. Objectives The objective of this analysis was to determine the predictive factors of early DAS28 improvement in PsA patients treated with infliximab (IFX) or golimumab (GLM) in a Canadian routine clinical care setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. The analysis was based on PsA patients treated with IFX or GLM between 2005 and 2014. Variables associated with improved response were examined using general linear models and those showing a statistical trend (P<0.150) were considered in multivariate analysis to identify independent predictors. Results A total of 176 patients were included in the analysis with a mean (SD) age of 49.4 (11.4) years and a disease duration of 5.2 (7.2) years. The majority of patients were male (54.1%). Upon 6 months of treatment statistically significant and clinically meaningful improvements were observed in DAS28 (4.1 vs. 2.9; P<0.001), HAQ (1.05 vs. 0.78; P<0.001), TJC (5.0 vs. 2.6; P<0.001), SJC (3.7 vs. 1.6; P<0.001), pain (46.8 vs. 30.7 mm; P<0.001), PtGA (48.6 vs. 29.7 mm; P<0.001), MDGA (5.3 vs. 2.3 cm; P<0.001), and morning stiffness (65.8 vs. 45.0 min; P<0.001). In univariate analysis, male gender (male vs. female: B=-0.806; P=0.029), not smoking (smokers vs. non-smokers: B=0.984; P=0.131), no previous use of a biologic (naïve vs. experienced: B=-1.995; P<0.001), presence of dactylitis (no vs. yes: B=0.746; P=0.073), and higher disease activity (DAS28 B=-0.525; P<0.001) were associated with greater improvements in DAS28 at six months of treatment. Age, disease duration, number of prior DMARDs, ongoing DMARD use, ongoing steroid use, ongoing NSAID use, presence of enthesitis, presence of nail pitting, and number of peri-articular manifestations did not show any effect on the change in DAS28. Multivariate analysis showed that, upon adjusting for baseline disease severity, male gender (B=-0.838; P=0.056) and no prior exposure to a biologic (B=-2.693; P=0.001) were significant predictors of improved response. Conclusions Six-month treatment with IFX or GLM in a real-world setting was associated with significant improvements in all disease parameters studied. Upon adjusting for potential confounders, no prior exposure to a biologic and male gender were identified as independent predictors of greater DAS28 improvement. Disclosure of Interest D. Sholter Consultant for: Janssen, J. Kelsall Consultant for: Janssen, R. Arendse Consultant for: Janssen, A. Avina-Zubieta Consultant for: Janssen, W. Bensen Consultant for: Janssen, M. Zummer Consultant for: Janssen, R. Faraawi Consultant for: Janssen, S. Dixit Consultant for: Janssen, M. Khraishi: None declared, I. Fortin Consultant for: Janssen, J. Sampalis: None declared, E. Psaradellis: None declared, F. Nantel Employee of: Janssen, C. Tkaczyk Employee of: Janssen, A. Lehman Employee of: Janssen
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Despite the importance of the Health Assessment Questionnaire (HAQ) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in assessing patient-reported functional status and disease activity, they have been critiqued for being time-consuming, not convenient on a daily-basis and thus not contributing to decisions in routine care. Objectives The aim of this analysis was to describe the correlation of individual HAQ and BASDAI questions with patient and physician reported measures used in AS and to examine whether the instruments could be reduced to better reflect routine clinical practice. Methods BioTRAC is an ongoing prospective registry of patients initiating infliximab or golimumab. Data from AS patients treated in 2005-2014 were used. The correlation of individual HAQ and BASDAI questions with patient (pain, BASDAI, HAQ and BASFI) and physician (MDGA) reported measures was described with the Pearson's correlation coefficient. The impact of each question on the need for help in each HAQ domain was assessed with logistic regression. Factor analysis was used to assess the variability due to each individual question in HAQ and BASDAI. Results A total of 413 AS patients with 1660 BASDAI and 1654 HAQ assessments were included. HAQ and BASDAI questions correlated at different extents with each AS measure. Questions related to “eating” and “gripping” showed the lowest correlation with patient and physician reported measures. All HAQ questions had higher correlations with patient reported measures than with MDGA. The BASDAI question on “fatigue and tiredness” showed the highest correlation with BASFI, while the question on “other joints pain/swelling” showed the lowest correlation with MDGA. None of the HAQ and BASDAI questions were associated with needing help for eating. All other HAQ individual questions were significantly associated with the need for help within their corresponding category, with the exception of Q5C and Q7A. BASDAI question on level of discomfort was significantly associated with the need for help in all HAQ categories, with the exception of “eating” and “walking”. Q2A and Q7C accounted for 59.6% of the HAQ variance. The level of morning stiffness accounted for 73.8% of the BASDAI variance. When combining the HAQ and BASDAI, Q2A and Q3A from HAQ and Q1 from BASDAI accounted for 63.5% of the variance. Conclusions Variability exists in the correlation of HAQ and BASDAI questions with patient and physician reported AS measures. The results suggest that “standing up straight from an armless chair” and “turning faucets on/off” are the main drivers of HAQ, while the level of morning stiffness drives the BASDAI. Three questions were found to drive the combined HAQ and BASDAI which may have implications in the design of self-report instruments. Disclosure of Interest P. Rahman Consultant for: Abbott, AbbVie, Amgen, BMS, Celgene, Janssen, Novartis, Pfizer, Roche, M. Zummer: None declared, W. Olszynski: None declared, M. Khraishi: None declared, D. Sholter: None declared, R. Faraawi Consultant for: Janssen, W. Bensen Consultant for: Janssen, M. Baker: None declared, A. Chow: None declared, J. Vaillancourt Employee of: JSS Medical Research, J. Sampalis Shareholder of: JSS Medical Research, F. Nantel Employee of: Janssen, S. Otawa Employee of: Janssen, A. Lehman Employee of: Janssen, C. Tkaczyk Employee of: Janssen, M. Shawi Employee of: Janssen
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Objective To determine the comparative effectiveness of oral versus subcutaneous methotrexate (MTX) as initial therapy for patients with early rheumatoid arthritis (ERA). Methods Patients with ERA (symptoms ≤1 year) initiating MTX therapy were included from a multicentre, prospective cohort study. We compared the effectiveness between starting with oral versus subcutaneous MTX over the first year. Longitudinal multivariable models, adjusted for potential baseline and time-varying confounders, were used to compare treatment changes due to inefficacy or toxicity and treatment efficacy (Disease Activity Score-28 (DAS-28), DAS-28 remission and Health Assessment Questionnaire-Disability Index (HAQ-DI)). Results 666 patients were included (417 oral MTX, 249 subcutaneous MTX). Patients prescribed subcutaneous MTX were prescribed a higher dose of MTX (mean dose over first three months 22.3 mg vs 17.2 mg/week). At 1 year, 49% of patients initially treated with subcutaneous MTX had changed treatment compared with 77% treated with oral MTX. After adjusting for potential confounders, subcutaneous MTX was associated with a lower rate of treatment failure ((HR (95% CI) 0.55 (0.39 to 0.79)). Most treatment failures were due to inefficacy with no difference in failure due to toxicity. In multivariable models, subcutaneous MTX was also associated with lower average DAS-28 scores (mean difference (−0.38 (95% CI −0.64 to −0.10)) and a small difference in DAS-28 remission (OR 1.2 (95% CI 1.1 to 1.3)). There was no significant difference in sustained remission or HAQ-DI (p values 0.43 and 0.75). Conclusions Initial treatment with subcutaneous MTX was associated with lower rates of treatment changes, no difference in toxicity and some improvements in disease control versus oral MTX over the first year in patients with ERA.
    No preview · Article · May 2015 · Annals of the Rheumatic Diseases

  • No preview · Article · Nov 2014
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    Full-text · Article · Sep 2014 · Arthritis Research & Therapy

  • No preview · Conference Paper · Jul 2014
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    ABSTRACT: Background The prevalence of rheumatoid arthritis (RA) is 2-4 times higher in women compared to men. Furthermore, RA incidence in women increases from the age of menarche peaking around menopause, while it is rare in men younger than 45 years (1). Several studies have shown that treatment outcomes are worse in women (2). Objectives This analysis examined gender-specific differences with respect to disease parameters at initiation of the first anti-TNF agent for RA treatment in a Canadian routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. In this analysis, data were assessed from RA patients treated with golimumab subcutaneous as a first biologic who were enrolled between 2010 and 2012. Results 121 RA patients were included with mean (SD) disease duration of 9.3 (9.6) years. Eighty-nine patients (73.6%) were female. In the overall population, rheumatoid factor positivity was observed in 67% of patients and 17.5% were smokers, without any significant differences between genders. Patient reported disease parameters differed significantly between genders. Despite the younger age (56.6 vs. 62.0 years; P=0.051), female patients reported significantly higher pain (56.6 vs. 44.5 mm; P=0.045), patient global assessment (PtGA: 6.0 vs. 4.7 cm; P=0.034), tender joint count (10.2 vs. 6.8; P=0.022), and functional disability (HAQ-DI: 1.43 vs. 1.06; P=0.024). In addition, a statistical trend towards higher morning stiffness in female patients was observed (55.7 vs. 38.9; P=0.063). However, physician assessment of global disease activity (MDGA: 5.7 vs. 5.5; P=0.581), SJC (7.9 vs. 8.5; P=0.641), DAS28-ESR (5.3 vs. 4.7; P=0.086), CDAI (29.7 vs. 24.5; P=0.120) and SDAI (32.1 vs. 30.2; P=0.675) were statistically comparable between genders. Conclusions Objective measures (SJC, CRP/ESR), MDGA and composite outcomes were similar for male and female patients at golimumab initiation, with the exception of TJC being higher in women. Patient reported outcomes (PROs: pain, PtGA, HAQ-DI), however, were worse at baseline for female patients at biologic treatment initiation. These findings are similar to our previous research on patients initiating anti-TNF IV therapy (3). Overall, the results may suggest gender bias in the interpretation and use of PROs during the treatment decision making process in Canadian RA patients. References Disclosure of Interest D. Sholter: None declared, W. Bensen: None declared, D. Choquette: None declared, I. Fortin: None declared, R. Arendse: None declared, J. Kelsall: None declared, M. Sheriff: None declared, R. Faraawi: None declared, J. Rodrigues: None declared, M. Zummer: None declared, S. Dixit: None declared, M. Starr: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.3979
    No preview · Conference Paper · Jul 2014
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    ABSTRACT: Background The efficacy of anti-TNF in the management of psoriatic arthritis (PsA) and rheumatoid arthritis (RA) has been demonstrated in numerous controlled clinical trials. Objectives The objective of this analysis was to assess in Canadian routine clinical practice the durability of treatment with infliximab (IFX) in PsA and RA and the determinants associated with sustainability of IFX. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for less than six months. Patients with PsA or RA treated with IFX who were enrolled between 2002 (2005 for PsA patients) and 2012 were included in this analysis. Dose optimization was defined as an increase in the frequency and/or dosing of IFX. Kaplan Meier (KM) estimates and Cox proportional models were used in the analysis. Results A total of 92 PsA and 830 RA patients were included in the analysis. Mean (SD) age of the PsA and RA patient cohorts was 48.7 (9.9) and 55.8 (13.4) years, respectively, and mean (SD) duration since diagnosis was 6.8 (9.1) and 10.2 (10.1) years, respectively. Twenty seven (29.3%) PsA patients and 407 (49.0%) RA patients had discontinued treatment. Overall KM-based mean (SE) duration of treatment was 41.4 (3.6) months and 61.3 (2.2) months for PsA and RA patients, respectively. Longer treatment duration was associated with significantly greater improvements in pain (parameter estimate PsA: -0.21, P=0.020; RA: -0.27, P<0.001), patient global (PsA: -0.35, P<0.001; RA: -0.28, P<0.001) and HAQ-DI (PsA: -0.01, P<0.001; RA: -0.01, P<0.001). Significant associations with duration of treatment in PsA patients were observed for disease duration (HR=1.04), previous biologic (HR=2.10), baseline TJC28 (HR=1.10), baseline PASI (HR=0.86) and concomitant use of traditional DMARD(s) (HR=0.16) or NSAID(s) (HR=0.38). For RA patients, IFX dose optimization (HR=0.72) and concomitant use of steroids (HR=1.78) were identified as significant predictors of treatment durability. Conclusions The results of this observational study have shown a high durability of treatment with IFX for patients with PsA or RA in a real-world setting. Concomitant medication use significantly impacts treatment durability. Furthermore, longer disease duration, higher TJC, less severe skin disease at initiation and previous biologic use in PsA, and absence of IFX dose optimization in RA, may be associated with reduced treatment durability. Disclosure of Interest J. Kelsall: None declared, A. Jovaisas: None declared, P. Rahman: None declared, D. Sholter: None declared, M. Starr: None declared, W. Bensen: None declared, M. Sheriff: None declared, W. Olszynski: None declared, M. Zummer: None declared, R. Faraawi: None declared, A. Chow: None declared, S. Kapur: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen Inc Canada, S. Otawa Employee of: Janssen Inc Canada, M. Shawi Employee of: Janssen Inc Canada, A. Lehman Employee of: Janssen Inc Canada DOI 10.1136/annrheumdis-2014-eular.4013
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background DAS28 is an important outcome for clinical research and practice assisting with therapeutic decisions. The main contributors to DAS28 are joint tenderness and acute-phase reactants. A simulation analysis showed that, due to its logarithmic transformation in the DAS28 formula, the ESR contribution is greater in the lower than in the higher DAS28 range. Objectives This analysis assessed the relative contribution of individual DAS28 components and examined its clinimetric properties in rheumatoid arthritis (RA) patients treated with infliximab in a Canadian real-world setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab or golimumab as first biologics or after treatment with a biologic for <6 months (M). RA patients treated with infliximab between 2002-2012 and with ≤60M of follow-up were included. The association between treatment duration and parameter improvement was assessed using linear regression. Slope correlation was assessed with the Pearson's correlation coefficient. Results 832 patients evaluated over 4,002 visits were included. Longer treatment duration was associated with significant (P<0.001) improvements in DAS28, TJC28, SJC28, PtGA, ESR, and CRP. Correlation analysis of the rate of change over time showed a high correlation (0.7-0.9) of DAS28 with TJC28, SJC28, and PtGA but low correlation with ESR (r=0.418) and CRP (r=0.411). Overall, the relative contribution of TJC28, SJC28, PtGA, and ESR in DAS28-ESR was 22%, 9%, 12%, and 57%, respectively. For DAS28-CRP, the relative TJC28, SJC28, PtGA, and CRP contributions were 25%, 10%, 12%, and 20%. Over 60M of treatment, the mean relative contribution of TJC28 (M0:31%, M60:17%), SJC28 (M0:15%, M60:5%), and PtGA (M0:15%, M60:9%) significantly (P<0.001) decreased whereas the weight of ESR contribution increased (M0:39%, M60:69%). Similar results were obtained with DAS28-CRP although the CRP contribution was lower compared to ESR. Increased DAS28-ESR was associated with higher relative contributions (per unit of DAS28-ESR increase) of TJC28 [parameter estimate (B) =5.3], SJC28 (B=2.1), and PtGA (B=0.7) but lower ESR contribution (B=-8.1). Similarly, increased DAS28-CRP was associated with lower relative CRP contribution (B=-2.0). Conclusions This analysis shows that TJC28 and acute-phase reactants have a greater weight than SJC28 and PtGA within DAS28. Furthermore, the relative contribution of acute-phase reactants is greater with lower DAS28, due to their logarithmic nature. These findings suggest that biologic variability and variability in laboratory techniques may have significant impact on classifying remission or DAS28 changes among patients with low DAS28 and on therapeutic plan changes. Disclosure of Interest D. Choquette: None declared, D. Sholter: None declared, I. Fortin: None declared, M. Starr: None declared, C. Thorne: None declared, M. Baker: None declared, R. Arendse: None declared, P. Baer: None declared, M. Zummer: None declared, J. Rodrigues: None declared, M. Sheriff: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2379
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Unlike rheumatoid arthritis (RA), the pattern of joint involvement in psoriatic arthritis (PsA) is usually asymmetric. Furthermore, PsA may demonstrate oligoarthritis or polyarthritis, while RA usually manifests in multiple joints. Objectives To describe the most commonly affected joints in patients with RA and PsA at baseline and after 6 months (mos) of treatment with infliximab (IFX) in a clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis, or PsA with IFX as first biologics or after having been treated with a biologic for <6 mos. RA patients treated between 2002-2012 and PsA patients treated with IFX between 2005-2012 were included. Based on the 28-joint involvement 7 groups were created: shoulder(s), elbow(s), metacarpophalangeal (MCP(s)), wrist(s), proximal interphalangeal (PIP(s)), knee(s), and thumb(s). The impact of treatment on joint swelling/tenderness was assessed with the McNemar test while the Chi-square test was used to compare the affected joints between disease groups. Results 832 RA patients (mean age: 55.8 yrs disease duration: 10.2 yrs) and 92 PsA patients (age: 48.7 yrs; disease duration: 6.8 yrs) were included. At baseline, mean DAS28, SJC28 and TJC28 in RA vs. PsA patients were 5.8 vs. 4.1 (P<0.001), 10.7 vs. 4.0 (P<0.001), and 12.6 vs. 5.9 (<0.001), respectively. Among RA patients, the joints most commonly swollen at baseline were MCPs (86.8% of patients), wrists (70.5%), and PIPs (53.2%). Knees, thumbs, elbows and shoulders were swollen in 42.3%, 33.7%, 30.5%, and 16.7% of patients, respectively (Figure 1A). With respect to tenderness, MCPs were tender in 83.8% of patients, wrists in 75.3%, shoulders in 57.8%, knees in 54.8%, PIPs in 55.3%, thumbs in 38.8%, and elbows in 41.0% (Figure 1B). Statistically significant differences were observed between RA and PsA patients both in the frequency of joint swelling/tenderness, which were lower in PsA, and the profile of affected joints. Among PsA patients, MCPs, wrists, and knees were the joints most commonly swollen, affected in 57.6%, 34.8%, and 31.5% of patients, respectively; MCPs, knees, and wrists were the joints most commonly tender (63.0%, 43.5%, and 42.4% of patients, respectively). Upon 6 mos of treatment, significant improvement in swelling/tenderness in all the most commonly affected joints in both RA and PsA patients was observed. The joints most resistant to treatment, still remaining affected at 6 mos, were MCPs in both patient groups. Conclusions Significant differences exist in both the frequency and the profile of swollen and tender joints in RA and PsA patients although both diseases shared the MCPs as the joint most commonly affected and most resistant to treatment. Treatment with IFX for 6 mos resulted in a significant reduction in the 28-swollen and tender joint counts in both RA and PsA patients. Disclosure of Interest A. Jovaisas: None declared, M. Starr: None declared, D. Choquette: None declared, M. Zummer: None declared, R. Arendse: None declared, D. Sholter: None declared, R. Faraawi: None declared, J. Rodrigues: None declared, S. Kapur: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, F. Nantel Employee of: Janssen, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2385
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background A definition of minimal disease activity (MDA) in PsA was derived from the opinion of 60 PsA experts including fulfillment of ≥5 of the 7 following criteria: tender joint count (TJC) ≤1, swollen joint count (SJC) ≤1, PASI ≤1 or body surface area ≤3%, pain (VAS) ≤15, patient global disease activity (PtGA) (VAS) ≤20, HAQ ≤0.5, and tender entheseal points ≤1 (1). Objectives To describe the rate of MDA achievement over time and to assess the association between MDA achievement and DAS28 remission in PsA patients treated with anti-TNF in a routine clinical practice setting. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis (RA), ankylosing spondylitis (AS), or PsA with infliximab or golimumab as first biologics or after having been treated with a biologic for <6 months. Data from PsA patients treated with infliximab (enrolled in 2005-2013) or golimumab (enrolled in 2010-2013) who had available MDA information at baseline, 6 months, and/or 12 months were included. Improvement in patient parameters over time was assessed for statistical significance with the paired-samples t-test. Agreement between MDA and remission as defined by the DAS28 (<2.6) criteria was assessed with the sensitivity, specificity, as well as the positive (PPV) and negative (NPV) predictive value. Results A total of 123 PsA patients with mean (SD) age of 50.5 (10.5) yrs and mean (SD) duration since diagnosis of 6.1 (7.3) yrs were included in this analysis, providing information from 340 assessments. At the time of enrollment in the registry, mean (SD) patient parameters were: DAS28 =4.2 (1.5), PASI =2.7 (4.8), SJC28 =4.1 (3.5), TJC28 =6.1 (5.6), morning stiffness =45.4 (43.0) min, health assessment questionnaire (HAQ-DI) =1.09 (0.65), physician global assessment of disease activity (MDGA) =5.3 (2.1), patient global assessment of disease activity (PtGA) =49.3 (27.3) mm, and pain =46.5 (25.2) mm. By 6 mos of treatment, statistically significant (P<0.05) improvements were observed in all clinical and patient outcome parameters studied, which were sustained or further enhanced over 12 months of treatment. The proportion of patients with MDA significantly increased from 12.3% at baseline to 45.0% after 6 months of treatment (P<0.001), and 41.9% at 12 mos (P=0.021). Similarly, DAS28 remission was observed in 15.9%, 47.8% and 45.1% of patients at baseline, 6 mos, and 12 mos, respectively. Using DAS28 as reference standard, sensitivity was 69.8%, specificity 93.0%, NPV 88.2%, and PPV 80.4%. Conclusions MDA has high discriminatory power for remission as defined by the DAS28 criteria, while being more rigorous than DAS28. Furthermore, treatment with anti-TNF is effective in inducing MDA in 45% of patients as early as 6 mos from treatment initiation. References Disclosure of Interest P. Rahman: None declared, S. Shaikh: None declared, M. Starr: None declared, W. Bensen: None declared, D. Choquette: None declared, W. Olszynski: None declared, M. Sheriff: None declared, M. Zummer: None declared, E. Rampakakis: None declared, J. Sampalis: None declared, A. Lehman Employee of: Janssen, S. Otawa Employee of: Janssen, F. Nantel Employee of: Janssen, V. Letourneau Employee of: Janssen, M. Shawi Employee of: Janssen DOI 10.1136/annrheumdis-2014-eular.2382
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Patient (PtGA) and physician (MDGA) assessment of global disease activity have been used as outcome measures individually or as part of composite scores in the measurement of rheumatoid arthritis (RA) disease severity and the evaluation of treatment effectiveness. However, discordance between the two is common1. The question arising is which global measure is a more valid predictor of disease remission. Objectives The aim of the analysis was to compare PtGA and MDGA with respect to their association with remission based on DAS-28, SDAI and CDAI, using a sequential cross-sectional analysis. Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab (IFX) or golimumab as first biologics or after having been treated with a biologic for <6 months. Eligible patients for this study included RA patients treated with IFX who were enrolled between 2002 and 2012 with available information on 6-, 12-, or 18-month remission. Logistic regression analysis with the parametric Wald statistic was used to compare the independent association of MDGA and PtGA with remission at 6, 12 and 18 months. The WALD statistic assesses the extent of contribution of an individual predictor to an outcome of interest and can be used to compare the contribution of different predictors. Results A total of 657 patients were included with mean (SD) age of 56.2 (13.5) years and disease duration of 10.1 (10.0) years. Significant (P<0.001) associations were observed between both PtGA and MDGA and achievement of remission at the corresponding assessments regardless of remission type. For DAS28 remission, the Wald statistic at 6, 12 and 18 months for MDGA vs. PtGA was 26.9 vs. 39.2, 12.7 vs. 35.9, and 19.8 vs. 22.5, respectively. For SDAI remission the MDGA and PtGA Wald statistics were 27.7 vs. 24.5, 27.8 vs. 28.5, and 32.4 vs. 23.4, respectively, at 6, 12 and 18 months. For CDAI remission, the Wald statistic for MDGA vs. PtGA at these time points was 34.8 vs. 26.9, 38.1 vs. 37.2, and 39.5 vs. 27.1. Similar results were obtained for predicting low disease activity. Conclusions The results of this analysis show that PtGA is a better predictor of DAS28 disease remission compared to MDGA. This could be explained by the fact that DAS28 includes PtGA and not MDGA. However, for CDAI and SDAI, physicians were better in predicting remission although the superiority of the MDGA was not consistent over time. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4276
    No preview · Article · Jun 2014 · Annals of the Rheumatic Diseases

  • No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Objectives Hospitalization is a major factor in health care costs and a surrogate for worse outcomes in chronic disease. The aim of this study was to determine the frequency of hospitalization secondary to lupus flare, the causes of hospitalization, and to determine risk factors for hospitalization in patients with systemic lupus erythematosus (SLE).Methods Data were collected as part of the 1000 Canadian Faces of Lupus, a prospective cohort study, where annual major lupus flares including hospitalizations were recorded over a 3-year period.ResultsOf 665 patients with available hospitalization histories, 68 reported hospitalization related to a SLE flare over 3 years of follow-up. The average annual hospitalization rate was 7.6% (range 6.6-8.9%). The most common reasons for hospitalization were: hematologic (22.1%), serositis (20.6%), musculoskeletal (MSK) (16.2%), and renal (14.7%). Univariate risk factors for lupus hospitalization included (OR [95% CI]; p < 0.05): juvenile-onset lupus (2.2 [1.1-4.7]), number of ACR SLE criteria (1.4 [1.1-1.7], baseline body mass index (BMI) (1.1 [1.0-1.1]), psychosis (3.4 [1.2-9.9]), aboriginal race (3.2 [1.5-6.7]), anti-Smith (2.6 [1.2-5.4]), erythrocyte sedimentation rate >25 mm/hr (1.9 [1.1-3.4]), proteinuria >0.5 g/d (4.2 [1.9-9.3], and SLAM-2 score (1.1 [1.0-1.2]). After multivariate regression only BMI, number of ACR criteria, and psychosis were associated with hospitalization for lupus flare.Conclusions The mean annual rate of hospitalization attributed to lupus was lower than expected. Hematologic, serositis, MSK and renal were the most common reasons. In a regression model elevated BMI, more ACR criteria and psychosis were associated with hospitalization.
    No preview · Article · Sep 2013 · Lupus
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    ABSTRACT: Objective: To examine the association between smoking and cutaneous involvement in systemic lupus erythematosus (SLE). Methods: We analyzed data from a multicenter Canadian SLE cohort. Mucocutaneous involvement was recorded at the most recent visit using the Systemic Lupus Erythematosus Disease Activity Index 2000 Update (rash, alopecia, and oral ulcers), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (alopecia, extensive scarring, and skin ulceration), and the ACR revised criteria for SLE (malar rash, discoid rash, photosensitivity, and mucosal involvement). Multivariate logistic regression models were used to estimate the independent association between mucocutaneous involvement and cigarette smoking, age, sex, ethnicity, lupus duration, medications, and laboratory data. Results: In our cohort of 1,346 patients (91.0% women), the mean ± SD age was 47.1 ± 14.3 years and the mean ± SD disease duration was 13.2 ± 10.0 years. In total, 41.2% of patients were ever smokers, 14.0% current smokers, and 27.1% past smokers. Active mucocutaneous manifestations occurred in 28.4% of patients; cutaneous damage occurred in 15.4%. Regarding the ACR criteria, malar rash was noted in 59.5%, discoid rash in 16.9%, and photosensitivity in 55.7% of patients. In the multivariate analysis, current smoking was associated with active SLE rash (odds ratio [OR] 1.63 [95% confidence interval (95% CI) 1.07, 2.48]). Having ever smoked was associated with ACR discoid rash (OR 2.36 [95% CI 1.69, 3.29]) and photosensitivity (OR 1.47 [95% CI 1.11, 1.95]), and with the ACR total cutaneous score (OR 1.50 [95% CI 1.22, 1.85]). We did not detect any associations between previous smoking and active cutaneous manifestations. No association was found between smoking and cutaneous damage or mucosal ulcers. No interaction was seen between smoking and antimalarials. Conclusion: Current smoking is associated with active SLE rash, and ever smoking with the ACR total cutaneous score. This provides additional motivation for smoking cessation in SLE.
    Full-text · Article · Aug 2013
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    ABSTRACT: Objective: To update estimates of cancer risk in SLE relative to the general population. Methods: A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Results: Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23). Conclusion: These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.
    No preview · Article · Feb 2013 · Journal of Autoimmunity
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    ABSTRACT: We aimed to determine disease severity and treatment of patients with psoriatic arthritis (PsA) in rheumatology practices in Canada through the PsA Assessment in Rheumatology (PAIR) study. Rheumatologists who were members of the Canadian Rheumatology Association were asked to complete a form for each patient addressing demographic questions, history, clinical examination, and patient-reported outcomes. Results were compared with a cohort seen in a PsA clinic during the same period. From across Canada, 22 rheumatologists from 5 provinces submitted information about 233 consecutive patients with PsA [145 men (62.2%), 88 women (37.8%), mean age 53.2 yrs (±12.7), 88.4% disease duration>2 yrs]. A majority (80.7%) fulfilled ClASsification for Psoriatic ARthritis (CASPAR) criteria, and 30% had taken no disease-modifying antirheumatic drugs. Clinical joint damage was documented in 60% of the patients, active skin disease in 70%, and nail lesions in 32%. Only 22% were rated as having moderate to high disease activity, while 52% were rated as low disease activity and 26% were deemed in remission. The decision was based on joint counts, patient global assessment, physician global assessment, and acute-phase reactants. Twenty-seven percent of the patients were to have their medications changed based on the current visit, the majority for inadequate response to medications. Patients in the PAIR cohort had more inflamed joints but similar damage to those in the PsA clinic. Patients with PsA seen in regular rheumatology practice fulfill CASPAR criteria, have active disease, and more than half have joint damage. The majority have low activity or are in remission.
    No preview · Article · Aug 2012 · The Journal of Rheumatology
  • Guillaume Chausse · Dafna Gladman · Michel Zummer

    No preview · Conference Paper · Aug 2012

Publication Stats

2k Citations
292.35 Total Impact Points

Institutions

  • 2008-2015
    • Université de Montréal
      • Department of Medicine
      Montréal, Quebec, Canada
    • University of Pittsburgh
      • Division of Rheumatology and Clinical Immunology
      Pittsburgh, Pennsylvania, United States
  • 2005-2014
    • Hôpital Maisonneuve-Rosemont
      Montréal, Quebec, Canada
  • 2011
    • Memorial University of Newfoundland
      Saint John's, Newfoundland and Labrador, Canada
  • 2009
    • University of Manitoba
      Winnipeg, Manitoba, Canada
  • 1993
    • Credit Valley Hospital
      Mississauga, Ontario, Canada