Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.
Myriad Genetics Inc., Salt Lake City, UT.
Rheumatology (Oxford). 2019 May 1;58(5):874-883. doi: 10.1093/rheumatology/key367.
To develop and evaluate an adjusted score for the multi-biomarker disease activity (MBDA) test to account for the effects of age, sex and adiposity in patients with RA.
Two models were developed to adjust MBDA score for age, sex and adiposity, using either serum leptin concentration or BMI as proxies for adiposity. Two cohorts were studied. A cohort of 325 781 RA patients who had undergone commercial MBDA testing and had data for age, sex and serum leptin concentration was used for both models. A cohort of 1411 patients from five studies/registries with BMI data was used only for the BMI-adjusted MBDA score. Univariate and multivariate linear regression analyses evaluated the adjusted MBDA scores and conventional clinical measures as predictors of radiographic progression, assessed in terms of modified total Sharp score (ΔmTSS).
Two models were developed, based on findings that MBDA score was higher in females than males and increased with age, leptin concentration and BMI. In pairwise regression analyses, the leptin-adjusted (P = 0.00066) and BMI-adjusted (P = 0.0027) MBDA scores were significant independent predictors of ΔmTSS after adjusting for DAS28-CRP, whereas DAS28-CRP was not, after adjusting for leptin-adjusted (P = 0.74) or BMI-adjusted (P = 0.87) MBDA score. Moreover, the leptin-adjusted MBDA score was a significant predictor of ΔmTSS after adjusting for the BMI-adjusted MBDA score (P = 0.025) or the original MBDA score (0.027), whereas the opposite was not true.
Leptin-adjusted MBDA score significantly adds information to DAS28-CRP and the original MBDA score in predicting radiographic progression. It may offer improved clinical utility for personalized management of RA.
开发和评估多生物标志物疾病活动（MBDA）检测的调整评分，以考虑 RA 患者的年龄、性别和肥胖的影响。
使用血清瘦素浓度或 BMI 作为肥胖的替代物，建立了两种调整 MBDA 评分的模型，以适应年龄、性别和肥胖。研究了两个队列。使用包含 325781 名接受过商业 MBDA 检测且具有年龄、性别和血清瘦素浓度数据的 RA 患者的队列，对这两种模型进行了研究。包含来自五个研究/注册处的 1411 名患者的 BMI 数据的队列仅用于 BMI 调整后的 MBDA 评分。使用单变量和多变量线性回归分析评估了调整后的 MBDA 评分和常规临床指标作为放射学进展的预测指标，评估指标为改良总 Sharp 评分（ΔmTSS）。
基于以下发现建立了两种模型：MBDA 评分在女性中高于男性，且随着年龄、瘦素浓度和 BMI 的增加而增加。在成对回归分析中，在调整 DAS28-CRP 后，瘦素调整（P=0.00066）和 BMI 调整（P=0.0027）的 MBDA 评分是ΔmTSS 的独立显著预测指标，而在调整瘦素调整（P=0.74）或 BMI 调整（P=0.87）的 MBDA 评分后，DAS28-CRP 不是。此外，在调整 BMI 调整后的 MBDA 评分（P=0.025）或原始 MBDA 评分（0.027）后，瘦素调整的 MBDA 评分是ΔmTSS 的显著预测指标，而相反的情况则不然。
瘦素调整后的 MBDA 评分在预测放射学进展方面，与 DAS28-CRP 和原始 MBDA 评分相比，提供了更有意义的信息。它可能为 RA 的个性化管理提供更好的临床实用性。
