Research (Abstract 2973) presented at the 2014 ACR/ARHP Annual Meeting included 143 patients in the BRASS registry at Harvard who had received a stable treatment over two years. They were evaluated at a single visit in the BRASS registry for the Vectra DA score and the conventional measures of CRP, DAS28-CRP, CDAI, SDAI and RAPID3. X-rays of their hands and wrists were obtained at the visit and two years later. Vectra DA was a better predictor of radiographic progression over two years when compared with the standard measures based on the exam or patient-reported outcomes. The odds ratio for predicting progression was highest for Vectra DA and lowest for RAPID3.
Eric Sasso, MD, vice president of medical and scientific affairs at Crescendo Bioscience, says the research indicates that a high Vectra DA score can occur even when CRP for conventional clinical measures show low disease activity or even remission. “When those types of discordance occur (i.e., high Vectra score indicating high disease activity in a patient with low CRP or low clinical measure of disease activity), those patients have an increased risk of ongoing joint damage.” These findings, he says, suggest that the Vectra DA test is detecting disease in some patients who appear to be in remission.
Vectra can provide additional information not readily available from conventional assessments, he says, such as when a patient appears to be in remission but actually has a risk of further joint damage. It can also be useful in the opposite kind of situation where the patient has a great deal of pain and appears to be doing poorly. “In some cases, the pain may be noninflammatory and the patient may not have much or any activity of their RA,” Dr. Sasso says. “Vectra DA can provide a completely objective way of assessing the contribution of rheumatoid inflammation.
“The role of Vectra DA is to measure the amount of disease activity. That information can be particularly important when deciding whether to change treatment, and the result can provide assurance as to whether the patient is doing well on current therapy,” Dr. Sasso says. “Vectra DA does not help with the decision about which therapy to select. That remains an area of great interest for ongoing research.”
Dr. Ruderman noted that rheumatologists who use Vectra do so to help them rule or rule out active disease and to quantify active disease. Those who don’t use it, he says, think it is an interesting approach but may not be much better than what they are currently using, such as CRP and DAS28 or a swollen and painful joint exam, which can be less expensive.