Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue

results from the British Society of Rheumatology Biologics Register for Rheumatoid Arthritis

Katie L. Druce, Gareth T Jones, Gary J Macfarlane, Neil Basu

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Abstract

OBJECTIVES: Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement.

METHODS: Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression.

RESULTS: In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)].

CONCLUSION: Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA fatigue management.

Original languageEnglish
Pages (from-to)964-971
Number of pages8
JournalRheumatology
Volume54
Issue number6
Early online date13 Oct 2014
DOIs
Publication statusPublished - 2015

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Rheumatology
Biological Products
Fatigue
Rheumatoid Arthritis
Odds Ratio
Therapeutics
Mental Health
Sex Ratio
Health Surveys
Observational Studies
Cohort Studies
Logistic Models
Steroids
Depression
Cytokines
Psychology
Hypertension

Keywords

  • fatigue
  • rheumatoid arthritis
  • anti-TNF

Cite this

@article{2293e750854f41b78f0ccac5092d4ae7,
title = "Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: results from the British Society of Rheumatology Biologics Register for Rheumatoid Arthritis",
abstract = "OBJECTIVES: Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement.METHODS: Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression.RESULTS: In 6835 participants the prevalence of severe baseline fatigue was 38.8{\%}. Of those with severe fatigue, 70{\%} reported clinically relevant improvement and 66{\%} moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95{\%} CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95{\%} CI 1.2, 1.7)], low disability [OR 1.2 (95{\%} CI 1.001, 1.5)], seropositivity [OR 1.2 (95{\%} CI 0.98, 1.4)], not using steroids [OR 1.2 (95{\%} CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95{\%} CI 1.1, 1.6)] or depression [OR 1.3 (95{\%} CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95{\%} CI 1.2, 1.7)].CONCLUSION: Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA fatigue management.",
keywords = "fatigue, rheumatoid arthritis, anti-TNF",
author = "Druce, {Katie L.} and Jones, {Gareth T} and Macfarlane, {Gary J} and Neil Basu",
note = "Acknowledgements The authors would like to thank the University of Manchester for access to the BSRBR-RA data and the BSR staff and Steering Committee for assistance with manuscript preparation. The BSRBR-RA is supported by a research grant from the BSR to the University of Manchester, which is indirectly funded by Schering Plough, Wyeth Laboratories, Abbott Laboratories and Amgen. Funding: This work forms part of K.L.D.’s Ph.D. dissertation, which is funded by the Institute of Applied Health Sciences, University of Aberdeen. Disclosure statement: N.B. has received research support from and/or served on advisory boards for Pfizer, MSD and GSK. All other authors have declared no conflicts of interest.",
year = "2015",
doi = "10.1093/rheumatology/keu390",
language = "English",
volume = "54",
pages = "964--971",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "OXFORD UNIV PRESS INC",
number = "6",

}

TY - JOUR

T1 - Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue

T2 - results from the British Society of Rheumatology Biologics Register for Rheumatoid Arthritis

AU - Druce, Katie L.

AU - Jones, Gareth T

AU - Macfarlane, Gary J

AU - Basu, Neil

N1 - Acknowledgements The authors would like to thank the University of Manchester for access to the BSRBR-RA data and the BSR staff and Steering Committee for assistance with manuscript preparation. The BSRBR-RA is supported by a research grant from the BSR to the University of Manchester, which is indirectly funded by Schering Plough, Wyeth Laboratories, Abbott Laboratories and Amgen. Funding: This work forms part of K.L.D.’s Ph.D. dissertation, which is funded by the Institute of Applied Health Sciences, University of Aberdeen. Disclosure statement: N.B. has received research support from and/or served on advisory boards for Pfizer, MSD and GSK. All other authors have declared no conflicts of interest.

PY - 2015

Y1 - 2015

N2 - OBJECTIVES: Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement.METHODS: Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression.RESULTS: In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)].CONCLUSION: Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA fatigue management.

AB - OBJECTIVES: Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement.METHODS: Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression.RESULTS: In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)].CONCLUSION: Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA fatigue management.

KW - fatigue

KW - rheumatoid arthritis

KW - anti-TNF

U2 - 10.1093/rheumatology/keu390

DO - 10.1093/rheumatology/keu390

M3 - Article

VL - 54

SP - 964

EP - 971

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 6

ER -