Heterogeneity in Patient Characteristics and Differences in Treatment Across 4 Canadian Rheumatoid Arthritis Cohorts

Glen S Hazlewood; Claire Bombardier; Xiuying Li; Mohammad Movahedi; Denis Choquette; Louis Coupal; Vivian P Bykerk; Orit Schieir; Dianne Mosher; Deborah A Marshall; Sasha Bernatsky; Nicole Spencer; Dawn P Richards; Laurie Proulx; Claire E H Barber; OBRI, RHUMADATA, CATCH Investigators, and the Rheum4U Team

doi:10.3899/jrheum.201688

Heterogeneity in Patient Characteristics and Differences in Treatment Across 4 Canadian Rheumatoid Arthritis Cohorts

J Rheumatol. 2022 Jan;49(1):16-25. doi: 10.3899/jrheum.201688. Epub 2021 Aug 1.

Authors

Glen S Hazlewood¹, Claire Bombardier², Xiuying Li³, Mohammad Movahedi⁴, Denis Choquette⁵, Louis Coupal⁵, Vivian P Bykerk⁶, Orit Schieir⁷, Dianne Mosher⁸, Deborah A Marshall⁹, Sasha Bernatsky¹⁰, Nicole Spencer¹¹, Dawn P Richards¹², Laurie Proulx¹², Claire E H Barber⁹; OBRI, RHUMADATA, CATCH Investigators, and the Rheum4U Team

Collaborators

OBRI, RHUMADATA, CATCH Investigators, and the Rheum4U Team:
Pooneh Akhavan, Murray Baron, Louis Bessette, Gilles Boire, Vivian P Bykerk, Ines Colmegna, Sabrina Fallavollita, Derek Haaland, Paul Haraoui, Glen Hazlewood, Carol Hitchon, Shahin Jamal, Raman Joshi, Edward Keystone, Bindu Nair, Peter Panopalis, Janet Pope, Laurence Rubin, Carter Thorne, Edith Villeneuve, Michel Zummer, Vivian P Bykerk, Susan J Bartlett, Louis Bessette, Giles Boire, Glen Hazlewood, Carol Hitchon, Edward Keystone, Janet Pope, Carter Thorne, Diane Tin, Vandana Ahluwalia, Zareen Ahmad, Pooneh Akhavan, Lori Albert, Catherine Alderdice, Michael Aubrey, Sangeeta Bajaj, William Bensen, Sankalp Bhavsar, Raja Bobba, Claire Bombardier, Arthur Bookman, Simon Carette, Raj Carmona, Andrew Chow, Patricia Ciaschini, Alfred Cividino, Dana Cohen, Sanjay Dixit, Derek Haaland, Brian Hanna, Nigil Haroon, Jacqueline Hochman, Anna Jaroszynska, Sindhu Johnson, Raman Joshi, Allan Kagal, Arthur Karasik, Jacob Karsh, Edward Keystone, Nader Khalidi, Bindee Kuriya, Margaret Larché, Arthur Lau, Nicole LeRiche, Felix Leung, Frances Leung, Dharini Mahendira, Mark Matsos, Heather McDonald-Blumer, Shikha Mittoo, Ami Mody, Angela Montgomery, Manisha Mulgund, Edward Ng, Tripti Papneja, Viktoria Pavlova, Louise Perlin, Janet Pope, Jane Purvis, Gina Rohekar, Sherry Rohekar, Thanu Ruban, Nooshin Samadi, Saeed Shaikh, Ali Shickh, Rachel Shupak, Doug Smith, Elaine Soucy, Jonathan Stein, Andrew Thompson, Carter Thorne, Sharon Wilkinson, Andrea Brose Emrick, Inelda Gjata, Dianne Mosher, Deborah Marshall, Claire Barber, Susa Benseler, Marinka Twilt, Paul MacMullan, Namneet Sandhu, Martina Stevenson

Affiliations

¹ G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, C.E.H. Barber, MD, PhD, Associate Professor of Medicine, Department of Medicine, University of Calgary, Department of Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada; [email protected].
² C. Bombardier, MD, FRCPC, Professor of Medicine, Department of Medicine University of Toronto, Toronto General Research Institute, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ X. Li, MSc, Ontario Best Practices Research Initiative (OBRI), Toronto, Ontario, Canada.
⁴ M. Movahedi, MD, PhD, Senior Research Associate, Assistant Professor of Epidemiology (Status Only), OBRI, Toronto, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁵ D. Choquette, MD, FRCPC, Professor of Medicine, L. Coupal, MSc, Université de Montréal, CHUM, Montreal, and RHUMADATA, Montreal, Quebec, Canada.
⁶ V.P. Bykerk, MD, FRCPC, Professor of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA.
⁷ O. Schieir, PhD, Canadian Early Arthritis Cohort (CATCH), Toronto, Ontario, Canada.
⁸ D. Mosher, MD, FRCPC, Associate Dean, Strategic Partnerships and Community Engagement, Professor of Medicine, Department of Medicine, University of Calgary, Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.
⁹ G.S. Hazlewood, MD, PhD, Associate Professor of Medicine, D.A. Marshall, PhD, Professor, Arthur J.E. Child Chair in Rheumatology Research, C.E.H. Barber, MD, PhD, Associate Professor of Medicine, Department of Medicine, University of Calgary, Department of Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
¹⁰ S. Bernatsky, MD, PhD, Department of Medicine, McGill University, Montreal, Quebec, Canada.
¹¹ N. Spencer, MSc, Research Assistant, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹² D.P. Richards, PhD, L. Proulx, BCom, Canadian Arthritis Patient Alliance, Canada.

PMID: 34334357
DOI: 10.3899/jrheum.201688

Abstract

Objective: To compare clinical characteristics and treatment of patients with rheumatoid arthritis (RA) across 4 Canadian cohorts.

Methods: The 4 longitudinal cohorts included the following: the Canadian Early Arthritis Cohort (CATCH; n = 2878), Ontario Best Practices Research Initiative (OBRI; n = 3734), RHUMADATA (Quebec, n = 2890), and the Rheum4U Precision Health Registry (Calgary, Alberta, n = 709). Data were from cohort inception (range 1998-2016) to 2020. Clinical characteristics and drug treatments were summarized descriptively.

Results: In total, 10,211 patients with RA were included. The percentage of patients who entered the cohort with early RA (2 yrs of disease at enrollment) ranged from 29% (Rheum4U) to 100% (CATCH). Mean age (55 yrs), sex (74% female), and seropositivity (69%) were similar between cohorts. At the time of initial disease-modifying antirheumatic drug (DMARD) use, median Disease Activity Score in 28 joints (DAS28) varied, ranging from 2.99 (Rheum4U) to 5.19 (CATCH), but were more similar at the time of the first DMARD switch (range 3.57-5.03), first biologic (bDMARD) or targeted synthetic DMARD (tsDMARD) use (range 4.01-4.67), and second bDMARD or tsDMARD (range 3.71-4.39). The initial DMARD was most commonly methotrexate, either in monotherapy (32%, range 18-40%) or dual therapy (34%, range 29-42%). The first DMARD switch was to another DMARD monotherapy in 20% (range 10-32%), dual therapy in 49% (range 39-56%), and bDMARD or tsDMARD in 24% (range 15-28%). The first bDMARD was an anti-tumor necrosis factor in 79% (range 78-82%).

Conclusion: Canadian RA cohorts demonstrate some heterogeneity in treatment, which could reflect differences in inclusion criteria, calendar year, or regional differences. This project is a first step toward conducting harmonized analyses across Canadian RA cohorts.

Keywords: registries; rheumatoid arthritis; therapeutics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / drug therapy
Biological Products* / therapeutic use
Female
Humans
Male
Methotrexate / therapeutic use
Middle Aged
Ontario

Substances

Antirheumatic Agents
Biological Products
Methotrexate

Grants and funding

CIHR/Canada