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

doi:10.1093/rheumatology/keu390

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

Research output: Contribution to journal › Article › peer-review

62 Citations (Scopus)

31 Downloads (Pure)

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 language	English
Pages (from-to)	964-971
Number of pages	8
Journal	Rheumatology
Volume	54
Issue number	6
Early online date	13 Oct 2014
DOIs	https://doi.org/10.1093/rheumatology/keu390
Publication status	Published - 2015

Bibliographical 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.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

fatigue
rheumatoid arthritis
anti-TNF

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10.1093/rheumatology/keu390Licence: Unspecified

Biologics Improvers Rheumatology
This is a pre-copyedited, author-produced PDF of an article accepted for publication in Rheumatology following peer review. The version of record Katie L. Druce, Gareth T. Jones, Gary J. Macfarlane, Neil Basu; Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis, Rheumatology, Volume 54, Issue 6, 1 June 2015, Pages 964–971 is available online at: https://doi.org/10.1093/rheumatology/keu390
Accepted author manuscript, 107 KBLicence: Unspecified

Cite this

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. / Druce, Katie L.; Jones, Gareth T ; Macfarlane, Gary J et al.
In: Rheumatology, Vol. 54, No. 6, 2015, p. 964-971.

Research output: Contribution to journal › Article › peer-review

@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.{\textquoteright}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 University Press",

number = "6",

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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

C2 - 25313148

SN - 1462-0324

VL - 54

SP - 964

EP - 971

JO - Rheumatology

JF - Rheumatology

IS - 6

ER -

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

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Gareth Jones

Gary Macfarlane

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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

Bibliographical note

UN SDGs

Keywords

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Gareth Jones

Gary Macfarlane

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