Faculty Bibliography

OBJECTIVE:To evaluate the utility of a web-based advocacy training tool in increasing advocacy awareness METHODS: Early career rheumatologists who attended 2019 ACR-Advocacy 101 were invited to participate. A web-based tool consisting of 9 cases covering various aspects of advocacy was developed and included the opportunity for continuing medical education credit. A pre-participation questionnaire surveyed prior involvement, knowledge, and willingness to participate in an advocacy program. Participants rated cases based on educational quality, relevance of content, achievement of training goals, competency, and evidence of bias. Two web-based conferences were held to address technical questions, review and discussion of cases and responses, and to obtain feedback. RESULTS:Twenty-one early career rheumatologists from 9 academic institutions enrolled, with 15 (75%) completing all cases. Correct CME answers were scored on 85% of cases. Overall educational quality of content received a mean rating of 4.3 out of 5. Seven cases achieved positive ratings for relevance of case content, achievement of training goals, objectivity, and competency. All cases were assessed free of bias. Feedback indicated 30 minutes was dedicated to each case, and a combination of skill set and content learning to be most effective. Pre- and post-questionnaire scores indicated significant improvement in knowledge of advocacy matters (p< 0.0001). CONCLUSION/CONCLUSIONS:A web-based advocacy training tool was successful in significantly improving awareness and knowledge of advocacy matters among early career rheumatologists. This innovative educational tool may play a vital role in shaping the future of rheumatology for both patients and physicians.

Population shifts in the workforce have been noted for the past few decades. In the United States, the number of people aged 65 and older is expected to double, reaching almost a quarter of the population.¹ By 2045, the US is expected to experience a demographic shift, with an increase in the percentage of minority populations to greater than 50%.

OBJECTIVE:To use unbiased, data-driven, principal component (PC) and cluster analysis to identify patient phenotypes of rheumatoid arthritis (RA) that might exhibit distinct trajectories of disease progression, response to treatment, and risk for adverse events. METHODS:Patient demographic, socioeconomic, health, and disease characteristics recorded at entry into a large, single-center, prospective observational registry cohort, the Brigham and Women's Rheumatoid Arthritis Sequential Study (BRASS; NCT01793103), were harmonized using PC analysis to reduce dimensionality and collinearity. The number of PCs was established by eigenvalue >1, cumulative variance, and interpretability. The resulting PCs were used to cluster patients using a k-means approach. Longitudinal clinical outcomes were compared between the clusters over 2 years. RESULTS:Analysis of 142 variables from 1443 patients identified 41 PCs that accounted for 77% of the cumulative variance in the dataset. Cluster analysis distinguished five patient clusters: (1) less RA disease activity/multimorbidity, shorter RA duration, lower incidence of comorbidities; (2) less RA disease activity/multimorbidity, longer RA duration, more infections, psychiatric comorbidities, healthcare utilization; (3) moderate RA disease activity/multimorbidity, more neurologic comorbidity; (4) more RA disease activity/multimorbidity, shorter RA duration, more metabolic comorbidity, higher BMI; (5) more RA disease activity/multimorbidity, longer RA duration, more hepatic, orthopedic comorbidity and RA-related surgeries. The clusters exhibited differences in clinical outcomes over 2 years of follow-up. CONCLUSION/CONCLUSIONS:Data-driven analysis of the BRASS registry identified five distinct phenotypes of RA. These results illustrate the potential of data-driven patient profiling as a tool to support personalized medicine in RA. Validation in an independent dataset is ongoing.

Background/Purpose: In the US, health care systems vary, as does cost sharing and access to various RA therapies. However, the burden of

Background/Purpose : Upadacitinib (UPA), an oral selective JAK1 inhibitor, has demonstrated favorable efficacy and acceptable safety in five Phase 3 global studies in patients with moderately to severely active rheumatoid arthritis (RA). 1-5 This analysis reports the efficacy and safety of UPA in predefined RA patient subgroups based on differences in baseline demographics and disease activity. Methods : Data were pooled from three pivotal, double-blind, PBO-controlled, multicenter, Phase 3 studies in patients with RA who had an inadequate response (IR) to conventional synthetic DMARDs (csDMARD-IR: SELECTNEXT [N=661]), MTX (MTX-IR; SELECT-COMPARE [N=1629]), or biologic DMARDs (bDMARD-IR: SELECT-BEYOND [N=498]). Two integrated analysis sets were evaluated: one comparing UPA 15 mg QD vs PBO (SELECT-NEXT, SELECT-COMPARE, SELECT-BEYOND) and the other comparing UPA 15 mg QD and UPA 30 mg QD vs PBO (SELECT-NEXT, SELECT-BEYOND). All patients received background treatment with csDMARDs. The proportion of patients achieving ACR20 and DAS28(CRP) <=3.2 at Week 12 was evaluated by predefined baseline demographics and disease activity measure groups, including age, sex, weight, BMI, race, geographic region, duration of RA, RF, and ACPA status, and level of high sensitivity CRP. Non-responder imputation was used for missing data. Subgroup analyses for safety were performed for age, race, sex, weight, BMI, and Asian region. Results : Across the three Phase 3 studies, 1036, 384, and 1041 patients received UPA 15 mg QD, UPA 30 mg QD or PBO, respectively. The demographic and baseline disease characteristics in the two integrated analysis sets were balanced across treatment groups. ACR20 and DAS28 <=3.2 response rates at Week 12 were consistently higher with UPA 15 mg and UPA 30 mg vs PBO across the evaluated demographic and baseline disease characteristics (Table). The efficacy of UPA 15 mg QD was generally similar to that observed with UPA 30 mg QD. At 12 weeks, the proportion of patients with treatment-emergent AEs, serious AEs, severe AEs, and AEs leading to discontinuation were generally comparable across different age, sex, race, weight, and BMI groups. Compared with the global population, patients receiving UPA in the Asian region had a higher rate of CPK elevations (UPA 30 mg only) and herpes zoster; herpes zoster also has been observed to be higher in the Asian region with other JAK inhibitors. 6,7 Conclusion : In this analysis of pooled integrated efficacy data in csDMARD-IR or bDMARD-IR patients with RA, UPA 15 mg or 30 mg QD in combination with csDMARDs improved efficacy outcomes at Week 12 when compared with PBO across all predefined subgroups evaluated. (Table Presented)

Rheumatoid arthritis (RA) management requires monitoring of disease activity to determine course of treatment. Global assessments are used in clinical practice to determine RA disease activity. Monitoring disease activity via biomarkers may also help providers optimize biologic and nonbiologic drug use while decreasing overall drug spend by delaying use of expensive biologic therapies. By testing multiple biologic domains at the same time, a multibiomarker disease activity test may have utility in RA patient management, through improved intra- and inter-rater reliability. This report provides a comprehensive review of studies of objective measures, single biomarkers and multibiomarker disease activity tests as disease activity measures to decrease uncertainty in treatment decisions, and of biomarkers' potential impact on economic and clinical outcomes of treatment choices.

OBJECTIVE: To identify how patients perceive the broad effect of active rheumatoid arthritis (RA) on their daily lives and indicate how RA disease management could benefit from the inclusion of individual goal-setting strategies. METHODS: Two multinational surveys were completed by patients with RA. The "Good Days Fast" survey was conducted to explore the effect of disease on the daily lives and relationships of women with RA. The "Getting to Your Destination Faster" survey examined RA patients' treatment expectations and goal-setting practices. RESULTS: Respondents from all countries agreed that RA had a substantial negative effect on many aspects of their lives (work productivity, daily routines, participation in social and leisure activities) and emotional well-being (loss of self-confidence, feelings of detachment, isolation). Daily pain was a paramount issue, and being pain- and fatigue-free was considered the main indicator of a "good day." Setting personal, social, and treatment goals, as well as monitoring disease progress to achieve these, was considered very beneficial by patients with RA, but discussion of treatment goals seldom appeared to be a part of medical appointments. CONCLUSION: Many patients with RA feel unable to communicate their disease burden and treatment goals, which are critically important to them, to their healthcare provider (HCP). Insights gained from these 2 surveys should help to guide patients and HCP to better focus upon mutually defined goals for continued improvement of management and achievement of optimal care in RA.