Arthritis Research Canada at
CRA & AHPA Annual Scientific Meeting 2023
Comparison of survival on treatment among new users of biosimilar vs. originator biologics in inflammatory arthritis: population-based evidence from a natural experiment due to a policy change.
Biologic medications have transformed the treatment of inflammatory types of arthritis due to their unparalleled effectiveness at stopping inflammation and preventing joint damage. But they are very costly. Biosimilars are near identical copies that are available at a lower cost, once the patent of the original drug expires. This study evaluated the BC Ministry of Health’s policy mandating that all new biologic prescriptions use a biosimilar when available. Using real world data from everyone in BC, the study showed that people prescribed biosimilars for etanercept and infliximab remain on treatment as long as people prescribed the originator, indicating the biosimilars are as safe and as effective.
Research Team: Lacaille D, Avina-Zubieta JA, Zheng Y, Lu N, Xie H.
To learn more about Arthritis Research Canada research presented at the CRA & AHPA Annual Scientific Meeting on February 9, please scroll down. We have research on rheumatoid arthritis, osteoarthritis, lupus, and much more.
In collaboration with researchers at Harvard University, Dr. Choi and her team created a novel cardiovascular risk calculator tool that includes lupus specific information to more accurately predict the risk of cardiovascular events, such as heart attacks, strokes and deaths from heart disease, in people with lupus. Their study showed that risk calculators currently used in clinical practice grossly underestimate the risk of cardiovascular events in people with lupus. Their lupus-specific cardiovascular risk calculator picked up twice as many patients who had a high-risk of serious cardiac events over the next 10 years. Accurately identifying people at high risk is an essential step in the prevention of heart disease in this population at high risk.
Research Team: Choi M, Webber B, Guan H, Yoshida K, Li D, Eldrodt J, Stevens E, Cai A, Everett B, Costenbader K.
Immunogenecity of Covid-19 Vaccines in Immune-mediated Inflammatory Diseases: Preliminary Results from the First 1251 SUCCEED Patients.
This large pan-Canadian study evaluated the effectiveness of COVID-19 vaccines in terms of antibody generation against COVID-19 in patients with auto-immune inflammatory diseases. At 3 months after the second vaccine dose, 78.6% of patients with rheumatoid arthritis had adequate antibodies against COVID-19, but only 45.5% of patients with Systemic sclerosis did.
Research Team:Kaplan G, Bowdish D, Larche M, Avina-Zubieta JA, Fortin PR, Gingras AC, Chandran V, Dayam R, Boire G, Lacaille D, Pereira D, Colmegna I, Lee JL, Baker B, Lee KA, Cook R, Quan J, Sharifi N, Richards D, Amiable N, Roux S, Benoit J, Hitchon C, Bernatsky S. SUCCEED Investigators.
Using Administrative Health Data to Construct a Frailty Index as a Measure of Susceptibility to Adverse Health Outcomes Among Individuals Living With Rheumatoid Arthritis.
We created a new tool, known as a frailty index, to measure the risk of worse health outcomes among individuals living with rheumatoid arthritis (RA). Using administrative health data for the province of British Columbia, we found that frailty index scores measured shortly after RA diagnosis predicted well later risk of emergency department visits, hospital admissions, and death.
Research Team: Legge A, Lacaille D
Utilization of a new educational platform designed to improve the care of cancer patients receiving immunotherapy: An initiative of CanRIO (The Canadian Research Group of Rheumatology in Immuno-oncology).
Immunotherapy is a relatively new treatment for cancer, which activates the body’s own immune system to fight cancer. In activating the immune system, off target side-effects can occur, affecting any organ system, including the musculoskeletal system. The Canadian Research Group of Rheumatology in Immuno-Oncology has developed a website www.canrio.ca to provide educational resources for physicians and patients. The website has successfully reached users from all over the world.
Research Team:Beckett N, Ye C, Ennis D, Hudson M, Jamal S, Katz S, Maltex N, Roberts J.
Preparing for a shared-care model: what proportion of patients with stable rheumatoid arthritis could be followed in primary care?
Often times, Rheumatologists are unable to tend to patients experiencing a sudden flare-up of their arthritis or people requiring a new diagnosis, due to their schedules being already occupied with pre-booked follow up appointments for patients with stable RA. Our study estimated that 20% of RA visits did not lead to treatment change and could be redirected to primary care, potentially freeing up clinic time for more urgent cases.
Research Team:Subdar S, Dhiman K, Hartfeld N, Lacaille D, Hoens A, Hazlewood G, Ward R, Lopatina E, Barber M, Manske S, Phillips L, MacMullan P, Mosher D, Fifi-Mah A, Jung M, Twilt M, Luca N, Then K, Crump T, Osinski K, Job B, Zafar S, Bhangu G, Barber CEH
False positive findings of large vessel vasculitis on FDG-PET in patients treated with immune checkpoint inhibitors: A case series.
This case series describes three instances where increased uptake into the walls of large vessel by a specialized scan called FDG-PET in patients with cancer treated by immune check point inhibitors did not represent true vasculitis. This phenomenon is important to recognize to avoid misinterpreting this as a side effect of treatment with immune check point inhibitors.
Research Team: Johnson D, Jamal S, Hung R, Ye C.
Levels of anti-mitochondrial antibodies are associated with disease manifestations and outcomes in systemic lupus erythematosus.
This international study of patients with lupus evaluated a type of antibodies against the self, called anti-mitochondrial antibodies, and found that the level of these antibodies predicted more severe outcomes and that this effect was influenced by sex, with the effect being more pronounced in women for some outcomes.
Research Team: Becker Y, Boilard E, Rollet-Labelle E, Lood C, Julien AS, Leclerc J, Levesque T, SLICC The Systemic Lupus Erythematosus International Collaborating Clinics, Fortin P.
Lived Educational Experience of Young Adults with Childhood- and Adult-Onset Systemic Lupus Erythematosus: A Multi-Center Canadian Qualitative Study.
We conducted qualitative interviews with Young Adults with Systemic Lupus Erythematosus (YASLE) to look at physical, cognitive and mental health issues that may impact employment. From five themes that emerged we found that ongoing social and school supports help to support them, and maintaining remote learning options may increase accessibility for them. These results identified opportunities for developing future supportive interventions for YASLE patients to better prepare them for future employment.
Research Team: Golding M, Fareha N, Merrill K, Kaur R, Stinson J, Protudjer J, Woodgate R, Peschken C, Lacaille D, Oguzoglu U, Touma Z, Lim L.
Sporadic inclusion body myositis, are a subset of autoimmune inflammatory diseases causing weakness of the muscles that are often difficult to diagnose. Using Machine Learning analysis of established and novel autoantibodies, we found that this type of myositis could be differentiated from other types of auto-immune myositis with an accuracy of up to 92%. Future studies to validate our findings in larger groups are needed.
Research Team: Wei J, Tarnopolsky M, Hudson M, Mitchell R, Dufour A, Almeida L, Fortin P, Boilard E Becker Y, Buhler K, Hather C, Zhang MF, Fritzler M, Choi M.
Cannabis Use in Inflammatory Arthritis: Characteristics and Comparisons Between Users and Non-Users.
We looked at cannabis use in people with inflammatory arthritis to find out reasons for use and whether disease features such as pain levels, fatigue, stress, etc. are different in cannabis users versus non-users. The data showed that people who used cannabis had more pain, fatigue, stress, depression, and worse overall health than non-users.
Research Team: Andersen N, McGuire É, Lacaille D, Savard J, Fortin PR, Rahme E, Da Costa D.
People with inflammatory arthritis are at a higher risk of developing depression. Findings from a survey used to evaluate an employment intervention for workers with inflammatory arthritis called Making It WorkTM , revealed that depression is associated with: insomnia, fatigue, having two or more diseases at the same time, job stress and demands, and being dissatisfied with work
Research Team: McGuire É, Luquini A, Sayre E, Lacaille D.
Accessing Telehealth and In-Person Healthcare during the COVID-19 Pandemic: Experiences of Individuals with Rheumatoid Arthritis.
This qualitative study provides valuable insights into how individuals with rheumatoid arthritis experienced seeking health services in British Columbia during the COVID-19 pandemic. Findings can inform the use of telehealth post-pandemic through addressing patient concerns, personalizing telehealth options, and integrating telehealth into clinical practice for routine check-ups.
Research Team: Ramachandran S, Leese J, Therrien S, Backman C, Ma J, English K, Davidson E, McQuitty S, Hoens AM, Koehn C, Gavin J, Adams J, Li L,
Decision-Making around Vaccination and Other Public Health Measures during the COVID-19 Pandemic: Experiences of Individuals with Rheumatoid Arthritis.
This qualitative study contributed important insights on how decision-making around adopting public health measures to reduce COVID-19 transmission raised ethical issues in the experiences of individuals with rheumatoid arthritis in British Columbia. These issues concern freedom of choice, social responsibility, and trust. Insights can help to support decision-making about public health measures in ways that value experiences of individuals with RA and other autoimmune diseases during the pandemic and beyond.
Research Team: Leese J, Therrien S, Ramachandran SO, Backman CL, Ma J, English K, Davidson E, McQuitty S, Hoens AM, Koehn C, Gavin J, Adams J, Li LC.
Inequities in Arthritis Care in Canada: The Black, Indigenous and Person of Colour (BIPOC) Experience.
Arthritis Consumer Experts, a patient advocacy organization, conducted an online survey to better understand health inequities experienced by Black, Indigenous and people of colour (BIPOC) in Canada. Respondents answered questions regarding sociodemographic information, access to arthritis care, interactions with health care providers and information seeking habits. Findings suggest that BIPOC respondents face significantly greater barriers when accessing arthritis care, and when they do, they benefit less from the care they receive. The data further reinforce literature that calls for culturally safe spaces which meaningfully address patient concerns and action equitable care.
Research Team: Wang E, Koehn C, Lendvoy K, Chan A, Canesco M, Sayre EC, Fox TL.
This study looked at the employment trajectory of young adults with lupus. Contrary to what is seen in youth from the general population, rates of employment did not increase with increasing age, and little to no increases in transitions from non-employed states to employment were observed. Difficulties in establishing employment during young adulthood is a major concern for this population.
Research Team: Lim L, Konstanidis M, Touma Z, Lacaille D, Oguzoglo U, Peschken C, Anderson N, Kaur R, Pullenayegum E
One Sixth of Canadian Newly Diagnosed RA Patients Treated in Routine Care Reported Sub-Optimal Adherence to Early DMARD Strategies Associated with Poorer Disease Control at 12-Months Follow-Up: Results from the Canadian Early Arthritis Cohort Study.
This study evaluated data from a pan Canadian study, the Canadian Early Arthritis Cohort, and found that approximately 1/6th of people with rheumatoid arthritis reported low or moderate adherence to their RA treatment in the first 6 months of their diagnosis. We found that unintentional reasons for non-adherence (such as forgetting or carelessness) were reported more frequently than intentional ones (such as stopping medications when arthritis is feeling good – or when having side effects from medication). This tells us that adherence to medications should be assessed early to get the best results from prescribed treatments, especially given the importance of early control of the disease on long term outcomes.
Research Team:Jiang Y, Schieir O, Valois MF, Bartlett S, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne , Bykerk V, Pope J.
We evaluated data on the number and type of medications being used in people with rheumatoid arthritis and lupus and found that polypharmacy (i.e. taking multiple medications) is very common amongst these patients and may reflect the level of disease control in this patient group.
Research Team: Berthelot W, Sirois C, Julien AS, Amiable N, Fortin PR.
Comparison of the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) and the FRAIL Scale for Identifying Frailty Among Individuals Living With Systemic Lupus.
Frailty is associated with poor health outcomes in systemic lupus erythematosus (SLE), but how best to measure frailty is unclear. We compared two different tools for identifying frailty among individuals living with SLE and found that each tool identified a similar, but not identical, group of patients. Additional research is needed to determine which frailty tools work best in different settings.
Research Team: Legge A, Lieber S, Hanly JG.
Systemic lupus erythematosus Women with lupus nephritis In pregnancy Therapeutic CHallenge (SWITCH)”: The Systemic Lupus International Collaborating Clinics experience.
One third of women with lupus develop lupus nephritis, a complication affecting the kidneys, and need to take medications that are not compatible with pregnancy. We evaluated practice patterns for these women, before and after pregnancy, focusing on methods that might provide opportunities to closely monitor the prescribed medications, or to use genetic testing to personalize therapy. We found both of these methods were used infrequently, as well as other care gaps that could be addressed by future research studies.
Research Team: Lee JY, Mendel A, Askanase A, Bae SC, Buyon J, Clarke AE, Costedoat-Chalumeau N, Fortin PR, Gladman D, Ramsey-Goldman R, Hanly JG, Inanc M, Isenberg D, Mak A, Mosca M, Petri M, Rahman A, Sanchez-Guerrero, Urowitz M, Wallace D, Bernatsky S, Vinet E.
Risk for Hospitalization, Intensive Care Unit Admission, and Mortality Among COVID-19 Patients Receiving Immunosuppressive Medications: A Population-Based SCOUT (underStanding COvid-19 in immUnosuppressed paTients) Study.
This population-based study of British Columbians found that risk of severe COVID-19 (hospitalization, admission to intensive care unit, or death) was significantly increased in people prescribed glucocorticoids or mycophenolate mofetil, a medication that suppresses the immune system. However, most other immunosuppressive or immunomodulatory agents did not have a significant impact on risk for severe outcomes of COVID-19.
Research Team: Tan J, Marozoff S, Lu N, Loree JM, Xie H, Lacaille D, Kopec JA, Esdaile JM, Corradetti B, Malone P, Koehn C, Mennell P, Hoens AM, Avina-Zubieta JA.
Trajectories of Depression in Adults with RA over the First 2 Years of the COVID-19 Pandemic: Results from the Canadian Early Arthritis Cohort (CATCH).
This study looked at symptoms of depression in the year prior to and throughout the first 2-years of the COVID-19 pandemic in adults with RA. The proportion of people in the study with at least mild symptoms of depression was more than double that reported for the Canadian population. People who reported worsening symptoms of depression were more likely to be female, obese, have higher pre-pandemic disease activity, more symptoms, disability, and higher impairments in participation. Given the impact of depression on quality of life, inflammation, and disease management, vulnerable groups may benefit from more frequent evaluation and additional support from rheumatology providers.
Research Team: Bartlett S, Schieir O, Valois MF, Pope J, Bessette L, Boire G, Hitchon C, Keysone E, Thorne C, Tin D, Hazlewood G, Bykerk V, CATCH Canadian Early Arthritis Cohort Investigators.
This study evaluated whether four previously identified criteria to determine if total knee replacement surgery is appropriate could predict patient’s likelihood of achieving a good outcome after surgery. Although validation is required, we encourage physicians to consider patients’ readiness, willingness, and expectations for surgery when making decisions about surgery, as doing so may improve the proportion of patients who experience a good surgical outcome.
Research Team:Hawker G, Bohm E, Dunbar M, Faris P, Jones A, Noseworthy T, Ravi B, Woodhouse L, Marshall D
Going Beyond Pain: Virtual Meetings and Survey to Expand the JIA Option Map with Other Symptoms and Functional Activities.
The juvenile idiopathic arthritis (JIA) Option Map, is a web-based patient decision aid for JIA pain. With a 35 member team of patient partners, healthcare professionals and researchers we identified physical and psychological symptoms, as well as a range of functional activities that should be added to the JIA Option Map to help young people with JIA manage symptoms and function in their daily life. Respondents to our survey felt that symptoms beyond pain, and ways to manage these additional symptoms, should be added to the app. Respondents rated fatigue, stress, anxiety, joint stiffness, poor sleep, feeling down and swelling as the most relevant to add to the app. Of the 17 who completed the survey, a total of 13 respondents felt that functional activities should be added, as well as tips to help young people participate in daily activities. All categories of functional activities were felt to be relevant, with school and leisure being rated the highest, followed by activities of daily living and work activities.
Research Team:Toupin-April K, Stringer E, Proulx L, Trehan N, Sirotich E, Abrahams N, Sirois A, Huber A, Duffy C, Morgan E, Cohen J, Gaboury I, Li L, Arman N, Birnie K, Cavallo S, Connelly M, Decary S, Duffy K, Gibbon M, Gmuca S, Knight A, Paterson G, Tugwell P, Stinson J.
Efficacy of COVID19 Vaccinations in Patients with Rheumatoid Arthritis (RA) and Systemic Sclerosis (SSc).
This large pan-Canadian study evaluated the effectiveness of COVID-19 vaccines in patients with auto-immune inflammatory diseases. Patients with systemic sclerosis were found to have a greater delay in mounting an antibody response than people with rheumatoid arthritis. Nevertheless, the rates of COVID infections and hospitalizations were low for both groups. More data is needed on different vaccine pairings to determine if there are vaccine-specific patterns of immunogenicity.
Research Team:Zimming Yan E, Heesels L, Lodhi S, Yerubandi A, Benoit J, Baker B, Bellini J, Mbuagbaw L, Bowdish D, Larche M, Kaplan G, Avina-Zubieta JA, Fortin PR, Gingras AC, Chandran V, Boire G, Lacaille D, Colmegna I, Hitchon C, Lee JL, Bernatsky S, SUCCEED Investigators Safety and immUnogenicity of Covid-19 vaCcines in systEmicimmunE mediated inflammatory Diseases.