AB0105 A SYSTEMATIC REVIEW OF THE MULTI-BIOMARKER DISEASE ACTIVITY SCORE FOR THE DIAGNOSIS AND TREATMENT IN RHEUMATOID ARTHRITIS
Authors: D. Abdelhafiz, M. Bukhari
Journal: Annals of the Rheumatic Diseases (2021)

Background: Biomarkers are important tools that can be used in the diagnosis and monitoring of rheumatoid arthritis (RA). The multi-biomarker disease activity (MBDA) score has shown a clinical value in the overall management of patients with RA. Objectives: To systematically explore the role of MBDA score for diagnosis and treatment of RA. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Key words used included: ‘Rheumatoid Arthritis’, ‘Biomarkers’, ‘Diagnosis’, ‘Treatment’, ‘Outcome’, ‘Response to treatment’, ‘Disease Activity’, and ‘MBDA’. The literature search included papers published in 2020 and in the English language. Results: This literature search has yielded 5 studies that investigated the impact of MBDA score on the diagnosis, treatment or disease progression of RA and have reported clear and clinically validated diagnostic or therapeutic effects. The first study prospectively investigated 130 patients with RA, and has shown that the MBDA score moderately correlated with disease activity at baseline ( r = 0.36 for adjusted MBDA score, r = 0.44 for unadjusted MBDA score) and at 16 weeks follow up ( r = 0.20 for adjusted MBDA, r = 0.30 unadjusted MBDA) but did not predict treatment response to methotrexate. There was also moderate correlation between MBDA scores and erythrocyte sedimentation rate (ESR) at baseline ( r = 0.54 and 0.59) and week 16 ( r = 0.42 and 0.51). The second was a cross-sectional study, which included 104 patients (50% female) and demonstrated that adjusted and unadjusted MBDA score correlated similarly with clinical disease activity. Adjustment for leptin reduced the influence of adiposity, particularly among women but significantly estimated higher disease activity in thin men and women. However, MBDA score predicted disease activity and response to tofacitinib treatment, measured by musculoskeletal ultrasound score (MSUS), in RA patients as demonstrated by the third prospective study that included 25 patients (all p&lt; 0.05). Correlation was found between baseline MSUS and MBDA score, and with 12-week changes in clinical disease activity (r = 0.45–0.62, p &lt; 0.05). Regression analysis showed associations between baseline MBDA score and 6-week (all p&lt; 0.05) and 12-week change in change in clinical disease activity (p= 0.03). The fourth prospective study which included 92 patients with RA, showed that MBDA could predict response to treatment of methotrexate with or without prednisolone. The improvement was faster in the first month of treatment followed by gradual improvement over the following 6 months. Changes from baseline to 12 months for disease activity and MBDA score showed a significant correlation for methotrexate and prednisolone ( r = 0.57, p = 0.002), methotrexate and placebo ( r = 0.57, p = 0.001) and for all groups ( r = 0.56, p&lt; 0.001). The final prospective study which included 148 patients, showed that MBDA predicted remission in RA and could differentiate between small differences in disease activity (low disease activity vs remission states). Baseline MBDA score discriminated baseline remission, area under the curve (AUC) 0.68-0.75, and intermittent/sustained remission (AUC 0.65-0.74). MBDA also predicted long term remission after one year. Conclusion: MBDA appears to be a useful tool in day-to-day clinical practice that can be used in the diagnosis, monitoring of treatment and prediction of outcomes of patients with RA. MBDA correlated well with disease activity and response to treatment. It is also a good predictor of long-term disease remission. Disclosure of Interests: None declared