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Predicted Versus Observed Radiographic Progression in Patients with Early Rheumatoid Arthritis (POPERA). Data from the SWEFOT (study 1), FIN-RACo/NEO-RACo (study 2), and NORD-STAR (study 3) Randomized Trials. The aim is to determine if POPERA is a valid tool that can estimate the relative radiographic efficacy of various treatments utilized in early rheumatoid arthritis

  • Study Title 1: Predicted Versus Observed Radiographic Progression in a Rheumatoid Arthritis Randomized Trial
  • Study Title 2: Predicted Versus Observed Radiographic Progression – Results from the FIN-RACo/NEO-RACo Randomized Trials
  • Study Title 3: Predicted Versus Observed Radiographic Progression – Results from the NORD-STAR Randomized Controlled Trial

Description of the study

POPERA is a prediction model of radiographic progression using data from 343 patients enrolled in the national Swedish Pharmacotherapy (SWEFOT) trial. POPERA simulates how patients with early rheumatoid arthritis would progress in their disease course in terms of total Sharp van der Heijde Score (SHS, bone erosion + joint-space narrowing) as if they were not on treatment versus observed progression. The prediction involved in the POPERA technique works through the creation of an inferred progression which equals the patient’s SHS at baseline divided by the disease duration in months prior to baseline, multiplied by 12 or 24 months + SHS baseline, respectively. This can then be compared to the observed progression, usually resulting in a reduction, and this change can then be compared with the changes observed in other treatments to find which is more effective. The SWEFOT trial had three different patient groups: methotrexate responders, patients on triple therapy (methotrexate + sulfasalazine + hydroxychloroquine), or patients on infliximab + methotrexate (anti-TNF). The last two groups were randomized and did not respond after 3-4 months to methotrexate monotherapy. After 24 months it was found from SWEFOT that those randomized to the anti-TNF arm had significantly better radiographic results but significance was not reached clinically (which had been reached at 12 months). The reason for the development of the POPERA study was to verify the SWEFOT findings and to determine if it is a tool that can simulate relative radiographic efficacy. We have had the honors in receiving radiographic data from our Finnish colleagues from their studies, FIN-RACo and NEO-RACo (144 and 90 patients, respectively), and this is the first time this data has been released outside of the FIN/NEO-RACo study group from the University of Tampere. This data also has patients who were on triple therapy or infliximab but now with a follow-up to five years and utilizes the Larsen score and SHS, respectively. The analysis of this data will be regarded as another study within this project after the SWEFOT POPERA results are sent to be published. The final study in this project is to utilize the same concept except to analyze the radiographic progression of a group of patients on different biologic treatments – certolizumab pegol (Cimzia), abatacept (Orencia) and tocilizumab (RoACTEMRA) vs. active conventional treatment – in the NORD-STAR randomized controlled trial that is being steered here at ClinTRID.

Expected to be completed

Study 1: 2014-03-30

Study 2: 2014-08-30


Study 1: Has been presented at EULAR and ACR 2013. Manuscript in progress
Study 2: Data from the FIN-RACo study group has been received
Study 3: Yet to begin

Contact information

Adrian Levitsky, Graduate student
Ronald van Vollenhoven
08-517 730 65