Browsing by Author "Bernardes, Miguel"
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- Biologic disease-modifying antirheumatic drugs survival in late-onset axial spondyloarthritis — data from a Portuguese registryPublication . Silva, Susana P.; Monteiro, Beatriz; Oliveira, Cláudia Pinto; Costa, Roberto Pereira da; Matos, Carolina Ochôa; Lopes, Mariana Diz; Gomes, Carlos Marques; Bernardes, Miguel; Santos, Mariana Emília; Gago, Laura; Abreu, Catarina; Fraga, Vanessa; Mendes, Beatriz; Rocha, Margarida Lucas; Soares, Catarina Dantas; Silva, Cândida; Santos, Helena; Valente, Paula; Silva, Lígia; Eugénio, Gisela; Barcelos, AnabelaObjectives Although axial spondyloarthritis (axSpA) typically begins before age 45, late-onset axSpA (lo-axSpA) has been widely recognized. While existing literature describes this subgroup, data on therapeutic approaches remain limited. Therefore, we aimed to evaluate the efficacy and safety of biologic DMARDs in patients with lo-axSpA.Methods We conducted a retrospective, multicentre, national cohort study using data from the Rheumatic Diseases Portuguese Register. A cut-off age of 45 years was applied to define lo-axSpA. Group differences between early- and late-onset disease activity scores were evaluated, and drug survival was assessed over 12 months. Predictors of drug discontinuation were identified using a Cox proportional hazards model.Results In total, 2256 patients were included, of whom 260 (11.5%) had lo-axSpA. Patients with late-onset disease exhibited significantly higher scores in the Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index at baseline, 3, 6 and 12 months. Despite these differences, both groups showed proportional reductions in disease activity scores, indicating a continuous decrease in disease activity over time. Although the late-onset group had a higher discontinuation rate during the first 12 months of treatment, lo-axSpA was not associated with an increased risk of therapy discontinuation. The primary reason for treatment discontinuation in both groups was inefficacy, with low rates of infections and other adverse events observed across the cohort.Conclusion Our study demonstrated that lo-axSpA is not associated with reduced treatment efficacy or compromised safety.
- Measuring quality of life of patients with axial spondyloarthritis for economic evaluationPublication . Hernandez Alava, Monica; Wailoo, Allan; Chrysanthou, Georgios; Barcelos, Filipe; van Gaalen, Floris A; Santos, Helena; Fagerli, Karen Minde; Gago, Laura; Margarida Cunha, Maria; van de Sande, Marleen; Couto, Maura C; Bernardes, Miguel; Ramonda, Roberta; Exarchou, Sofia; PD, Carvalho; van der Heijde, Desirée; Machado, Pedro MObjectives To estimate the relationship between EQ5D (three levels, UK version) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) for use in the economic evaluation of health technologies for people with axial spondyloarthritis (axSpA). To compare against the relationship with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Methods An electronic, prospective, Portuguese, nationwide, rheumatic disease register (Reuma.pt) provided data on 1140 patients (5483 observations) with a confirmed diagnosis of axSpA. We estimated models of EQ5D as a function of ASDAS, alone or in combination with measures of functional impairment, using bespoke mixture models which reflect the complex distributional features of EQ5D. The SPondyloArthritis Caught Early cohort provided data from 344 patients (1405 observations) in four European countries and was used for validation. A previously published model of BASDAI/Bath Ankylosing Spondylitis Functional Index (BASFI) was also used to generate predicted EQ5D scores and model performance compared. Results A non-linear relationship exists between EQ5D from ASDAS. The final model included ASDAS, ASDAS squared, age and age squared and demonstrated close fit in both datasets except where data were sparse for patients with very high levels of disease activity (ASDAS >4). This finding held in the validation dataset. Models that included BASFI improved model fit. The ASDAS based models fit the data marginally less well than models using BASDAI. Conclusions Mapping models linking ASDAS to EQ5D allow results from clinical studies to be used in economic evaluation of health technologies with confidence. There is some loss of information compared with BASDAI but this has only a marginal impact.