Rheumatoid Arthritis
Conditions
Keywords
Evaluation of safety and efficacy, Adalimumab treatment, Rheumatoid Arthritis
Brief summary
The objectives of the study are to observe and assess the long-term use, safety and efficacy of Humira (adalimumab), as prescribed by the rheumatologist in a normal clinical setting and in accordance with the terms of the European marketing authorization and to observe compliance of patients with the prescribed treatment.
Detailed description
This is a multi-center, uncontrolled observational study of patients who at the time of entry had moderate to severe rheumatoid arthritis (RΑ) and who were subsequently prescribed Humira (adalimumab) following normal clinical practice, with or without other anti-rheumatic treatments, prior to enrollment in this study. Once the physician has determined that the patient meets the inclusion criteria, and the patient has agreed to be included in the observational study by signing the informed consent, the patient's Day 1 demographic data, and disease status will be reported in the Day 1 Data Report Forms. The physician will then follow-up with the patient via regular office visits at intervals as determined by routine clinical practice. Patient's safety and efficacy data, if they are part of clinical routine, will be recorded in the Data Report Forms at Day 1, and regular visits which are closest to Month 3, Month 6, Month 9, Month 12, Month 18, Month 24, Month 30, and Month 36.
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients with moderate or severe active rheumatoid arthritis, who have been prescribed and are receiving Humira (adalimumab) under normal clinical practice for at least one month prior to inclusion and according to the approved Summary of Product Characteristics (SPC) in the European Union. * Patients must be willing to consent to data being collected and provided to Abbott Laboratories.
Exclusion criteria
* Contraindications according to the SPC. * Patients should not participate in another observational Abbott study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| European League Against Rheumatism (EULAR) Response | Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36 | A EULAR response reflects an improvement in disease activity and an attainment of a lower degree of disease activity based on the DAS28 score. The DAS28 score ranges from 0-10, with higher scores indicating more disease activity. A Good EULAR Response is defined as an improvement (decrease) in the DAS28 of \> 1.2 compared with Baseline and attainment of a DAS28 score of ≤ 3.2. A Moderate EULAR Response is defined as either: * an improvement (decrease) in the DAS28 of \> 0.6 and ≤ 1.2 from Baseline and attainment of a DAS28 score of ≤ 5.1, or * an improvement (decrease) in the DAS28 of \> 1.2 from Baseline and attainment of a DAS28 score of \> 3.2. No Response is defined as either: * an improvement (decrease) in the DAS28 of ≤ to 0.6, or * an improvement (decrease) in the DAS28 of \> 0.6 and ≤ 1.2 and attainment of a DAS28 of \> 5.1. |
| Number of Participants With Adverse Events | 3 years | An adverse event (AE) is defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. If an adverse event meets any of the following criteria, it is considered a serious adverse event (SAE): Results in death, is life-threatening, results in hospitalization or the prolongation of hospitalization, is a congenital anomaly or a persistent or significant disability/incapacity, is an event that results in a condition that substantially interferes with the activities of daily living of the participant, is an important medical event requiring medical or surgical intervention to prevent a serious outcome, spontaneous abortion or miscarriage experienced by the participant, or an elective abortion performed on the participant. |
| Disease Activity Score (DAS) 28 Over Time | Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36 | The DAS28 is a validated index of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, C reactive protein, and general health are included in the DAS28 score. Scores on the DAS28 range from 0 to 10. A DAS28 score \>5.1 indicates high disease activity, a DAS28 score \<3.2 indicates low disease activity, and a DAS28 score \<2.6 indicates clinical remission. |
| Number of Participants With an American College of Rheumatology (ACR) 70 Response | Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36 | American College of Rheumatology 70% (ACR70) response. A participant was a responder if the following 3 criteria for improvement from Baseline were met: * ≥ 70% improvement in tender joint count; * ≥ 70% improvement in swollen joint count; and * ≥ 70% improvement in at least 3 of the 5 following parameters: * Patient's assessment of pain (measured on a 100 mm visual analog scale \[VAS\]); * Patient's global assessment of disease activity (measured on a 100 mm VAS); * Physician's global assessment of disease activity (measured on a 100 mm VAS); * Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index \[HAQ-DI\]); * Acute phase reactant value (C-reactive protein \[CRP\]). |
| Number of Participants With an American College of Rheumatology (ACR) 20 Response | Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36 | American College of Rheumatology 20% (ACR20) response. A participant was a responder if the following 3 criteria for improvement from Baseline were met: * ≥ 20% improvement in tender joint count; * ≥ 20% improvement in swollen joint count; and * ≥ 20% improvement in at least 3 of the 5 following parameters: * Patient's assessment of pain (measured on a 100 mm visual analog scale \[VAS\]); * Patient's global assessment of disease activity (measured on a 100 mm VAS); * Physician's global assessment of disease activity (measured on a 100 mm VAS); * Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index \[HAQ-DI\]); * Acute phase reactant value (C-reactive protein \[CRP\]). |
| Number of Participants With an American College of Rheumatology (ACR) 50 Response | Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36 | American College of Rheumatology 50% (ACR50) response. A participant was a responder if the following 3 criteria for improvement from Baseline were met: * ≥ 50% improvement in tender joint count; * ≥ 50% improvement in swollen joint count; and * ≥ 50% improvement in at least 3 of the 5 following parameters: * Patient's assessment of pain (measured on a 100 mm visual analog scale \[VAS\]); * Patient's global assessment of disease activity (measured on a 100 mm VAS); * Physician's global assessment of disease activity (measured on a 100 mm VAS); * Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index \[HAQ-DI\]); * Acute phase reactant value (C-reactive protein \[CRP\]). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Missed at Least One Dose of Humira | Months 3, 6, 9, 12, 18, 24, 30, and 36 | Compliance to study treatment was measured by the percentage of participants who missed at least one dose of Humira during each time interval between study visits. |
Countries
Greece
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Humira Participants with rheumatoid arthritis treated with Humira (adalimumab) as prescribed by the rheumatologist in the setting of routine clinical care. | 566 |
| Total | 566 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 42 |
| Overall Study | AE and Lack of Efficacy | 4 |
| Overall Study | AE and Lost to Follow-up | 1 |
| Overall Study | AE and Other Reason | 1 |
| Overall Study | AE and Withdrew Consent | 5 |
| Overall Study | AE, Withdrew Consent & Lack of Efficacy | 1 |
| Overall Study | Death | 1 |
| Overall Study | Lack of efficacy/Exacerbation of RA | 86 |
| Overall Study | Lost to Follow-up | 86 |
| Overall Study | Other | 14 |
| Overall Study | Withdrawal by Subject | 41 |
| Overall Study | Withdrew Consent and Lack of Efficacy | 5 |
| Overall Study | Withdrew consent and Other Reason | 4 |
Baseline characteristics
| Characteristic | Humira |
|---|---|
| Age Continuous | 56.8 years STANDARD_DEVIATION 13.2 |
| Region of Enrollment Greece | 566 participants |
| Sex: Female, Male Female | 456 Participants |
| Sex: Female, Male Male | 110 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 109 / 566 |
| serious Total, serious adverse events | 65 / 566 |
Outcome results
Disease Activity Score (DAS) 28 Over Time
The DAS28 is a validated index of rheumatoid arthritis disease activity. Twenty-eight tender joint counts, 28 swollen joint counts, C reactive protein, and general health are included in the DAS28 score. Scores on the DAS28 range from 0 to 10. A DAS28 score \>5.1 indicates high disease activity, a DAS28 score \<3.2 indicates low disease activity, and a DAS28 score \<2.6 indicates clinical remission.
Time frame: Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36
Population: Safety population; n indicates the number of participants with available data at each time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 6 (n=449) | 3.8 units on a scale | Standard Deviation 1.5 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 24 (n=298) | 3.2 units on a scale | Standard Deviation 1.5 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 30 (n=264) | 3.0 units on a scale | Standard Deviation 1.4 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 36 (n=254) | 2.9 units on a scale | Standard Deviation 1.4 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Baseline (n=555) | 6.0 units on a scale | Standard Deviation 1.2 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 3 (n=510) | 4.2 units on a scale | Standard Deviation 1.4 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 9 (n=401) | 3.5 units on a scale | Standard Deviation 1.5 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 12 (n=379) | 3.5 units on a scale | Standard Deviation 1.5 |
| Humira | Disease Activity Score (DAS) 28 Over Time | Month 18 (n=333) | 3.3 units on a scale | Standard Deviation 1.5 |
European League Against Rheumatism (EULAR) Response
A EULAR response reflects an improvement in disease activity and an attainment of a lower degree of disease activity based on the DAS28 score. The DAS28 score ranges from 0-10, with higher scores indicating more disease activity. A Good EULAR Response is defined as an improvement (decrease) in the DAS28 of \> 1.2 compared with Baseline and attainment of a DAS28 score of ≤ 3.2. A Moderate EULAR Response is defined as either: * an improvement (decrease) in the DAS28 of \> 0.6 and ≤ 1.2 from Baseline and attainment of a DAS28 score of ≤ 5.1, or * an improvement (decrease) in the DAS28 of \> 1.2 from Baseline and attainment of a DAS28 score of \> 3.2. No Response is defined as either: * an improvement (decrease) in the DAS28 of ≤ to 0.6, or * an improvement (decrease) in the DAS28 of \> 0.6 and ≤ 1.2 and attainment of a DAS28 of \> 5.1.
Time frame: Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36
Population: Safety population;
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Humira | European League Against Rheumatism (EULAR) Response | Month 24 (n=294) | 169 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 9 (n=394) | 173 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 3 (n=501) | 112 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 12 (n=373) | 171 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 18 (n=327) | 168 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 6 (n=443) | 154 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 36 (n=253) | 156 participants |
| Humira | European League Against Rheumatism (EULAR) Response | Month 30 (n=262) | 155 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 24 (n=294) | 84 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 12 (n=373) | 139 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 36 (n=253) | 68 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 18 (n=327) | 105 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 3 (n=501) | 242 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 30 (n=262) | 78 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 6 (n=443) | 193 participants |
| Moderate Response | European League Against Rheumatism (EULAR) Response | Month 9 (n=394) | 147 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 18 (n=327) | 54 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 24 (n=294) | 41 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 30 (n=262) | 29 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 36 (n=253) | 29 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 3 (n=501) | 147 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 6 (n=443) | 96 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 9 (n=394) | 74 participants |
| No Response | European League Against Rheumatism (EULAR) Response | Month 12 (n=373) | 63 participants |
Number of Participants With Adverse Events
An adverse event (AE) is defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. If an adverse event meets any of the following criteria, it is considered a serious adverse event (SAE): Results in death, is life-threatening, results in hospitalization or the prolongation of hospitalization, is a congenital anomaly or a persistent or significant disability/incapacity, is an event that results in a condition that substantially interferes with the activities of daily living of the participant, is an important medical event requiring medical or surgical intervention to prevent a serious outcome, spontaneous abortion or miscarriage experienced by the participant, or an elective abortion performed on the participant.
Time frame: 3 years
Population: The safety population, including all patients that received at least one dose of the study drug.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Humira | Number of Participants With Adverse Events | Any Adverse Event | 262 participants |
| Humira | Number of Participants With Adverse Events | Serious Adverse Event | 65 participants |
Number of Participants With an American College of Rheumatology (ACR) 20 Response
American College of Rheumatology 20% (ACR20) response. A participant was a responder if the following 3 criteria for improvement from Baseline were met: * ≥ 20% improvement in tender joint count; * ≥ 20% improvement in swollen joint count; and * ≥ 20% improvement in at least 3 of the 5 following parameters: * Patient's assessment of pain (measured on a 100 mm visual analog scale \[VAS\]); * Patient's global assessment of disease activity (measured on a 100 mm VAS); * Physician's global assessment of disease activity (measured on a 100 mm VAS); * Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index \[HAQ-DI\]); * Acute phase reactant value (C-reactive protein \[CRP\]).
Time frame: Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36
Population: Safety population; the analysis was performed on the basis of non-missing information and no imputation methods were used. n indicates the number of patients for whom ACR20 could be calculated at each time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 9 (n=384) | 263 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 12 (n=363) | 248 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 18 (n=330) | 241 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 24 (n=293) | 216 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 30 (n=259) | 198 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 36 (n=248) | 194 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 3 (n=491) | 265 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 20 Response | Month 6 (n=427) | 279 participants |
Number of Participants With an American College of Rheumatology (ACR) 50 Response
American College of Rheumatology 50% (ACR50) response. A participant was a responder if the following 3 criteria for improvement from Baseline were met: * ≥ 50% improvement in tender joint count; * ≥ 50% improvement in swollen joint count; and * ≥ 50% improvement in at least 3 of the 5 following parameters: * Patient's assessment of pain (measured on a 100 mm visual analog scale \[VAS\]); * Patient's global assessment of disease activity (measured on a 100 mm VAS); * Physician's global assessment of disease activity (measured on a 100 mm VAS); * Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index \[HAQ-DI\]); * Acute phase reactant value (C-reactive protein \[CRP\]).
Time frame: Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36
Population: Safety population; the analysis was performed on the basis of non-missing information and no imputation methods were used. n indicates the number of patients for whom ACR50 could be calculated at each time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 12 (n=368) | 182 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 36 (n=250) | 164 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 3 (n=498) | 134 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 6 (n=433) | 188 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 9 (n=388) | 205 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 18 (n=333) | 184 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 24 (n=291) | 170 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 50 Response | Month 30 (n=256) | 161 participants |
Number of Participants With an American College of Rheumatology (ACR) 70 Response
American College of Rheumatology 70% (ACR70) response. A participant was a responder if the following 3 criteria for improvement from Baseline were met: * ≥ 70% improvement in tender joint count; * ≥ 70% improvement in swollen joint count; and * ≥ 70% improvement in at least 3 of the 5 following parameters: * Patient's assessment of pain (measured on a 100 mm visual analog scale \[VAS\]); * Patient's global assessment of disease activity (measured on a 100 mm VAS); * Physician's global assessment of disease activity (measured on a 100 mm VAS); * Patient's self-assessment of physical function (Health Assessment Questionnaire - Disability Index \[HAQ-DI\]); * Acute phase reactant value (C-reactive protein \[CRP\]).
Time frame: Baseline and Months 3, 6, 9, 12, 18, 24, 30, and 36
Population: Safety population; the analysis was performed on the basis of non-missing information and no imputation methods were used. n indicates the number of patients for whom ACR70 could be calculated at each time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 3 (n=495) | 67 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 6 (n=435) | 118 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 9 (n=390) | 147 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 12 (n=373) | 142 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 18 (n=330) | 154 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 24 (n=294) | 149 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 30 (n=261) | 139 participants |
| Humira | Number of Participants With an American College of Rheumatology (ACR) 70 Response | Month 36 (n=253) | 144 participants |
Percentage of Participants Who Missed at Least One Dose of Humira
Compliance to study treatment was measured by the percentage of participants who missed at least one dose of Humira during each time interval between study visits.
Time frame: Months 3, 6, 9, 12, 18, 24, 30, and 36
Population: Safety population; n indicates the number of participants with available data at each time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 3 (n=512) | 6.6 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 6 (n=451) | 8.6 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 9 (n=406) | 7.4 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 12 (n=384) | 7.3 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 18 (n=341) | 8.2 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 24 (n=303) | 7.6 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 30 (n=271) | 5.5 percentage of participants |
| Humira | Percentage of Participants Who Missed at Least One Dose of Humira | Month 36 (n=262) | 4.2 percentage of participants |