No improvement in RA outcomes with SMS-enhanced monitoring
medwireNews: A Finnish trial has shown no significant improvement in the outcomes of patients with early rheumatoid arthritis (RA) who are monitored using an automated text message (SMS)-enhanced approach versus the standard approach.
The failure of the trial to meet its primary endpoint could be due to “the notably high overall remission rates” in both the intervention and control arms, in turn potentially explained by the fact that in Finland “[t]he care of early RA is highly optimized and therefore difficult to improve,” say the investigators.
They therefore suggest that “[patient] groups whose care is less optimized might benefit more from similar interventions.”
A total of 162 DMARD-naïve patients recruited from six hospitals were randomly assigned to monitoring using the SMS-enhanced or routine approach. Participants in the intervention group received 13 text messages at intervals of 1–2 weeks during the 6-month trial period; the texts aimed to identify individuals with poor medication adherence and those who were responding poorly to medication, based on the patient’s assessment of disease activity. Responses below a prespecified threshold triggered a phone call from a nurse, who consulted a physician if needed.
The primary endpoint of strict Boolean response – defined as no tender or swollen joints (46 joint count) and normal C-reactive protein levels – at 6 months was achieved by 51% of the 82 participants who received SMS-enhanced monitoring and 42% of the 80 patients who received routine monitoring, with no significant difference between the groups.
Patients in both groups also achieved comparable DAS28 scores at the 6-month timepoint, decreasing from an average of 4.10 points at baseline to 1.92 points in the intervention arm, and from 4.40 to 2.22 points in the control arm.
The results were similar at 12 months, with no significant differences between the SMS-enhanced and routine monitoring groups in either rates of strict Boolean response (57 vs 43%) or DAS28 scores (mean, 1.79 vs 2.08 points).
The number of nurse phone calls was significantly higher in the intervention than control group, at an average of 3.32 and 2.00, respectively, but the number of unscheduled nurse and physician visits, and physician phone calls were comparable between groups.
And although most of the participants who used it were “very satisfied” with the SMS-based monitoring system and “felt secure and satisfied with their treatment,” Laura Kuusalo, from Turku University Hospital, and team note that this did not translate into a significant improvement in either quality of life or reported adverse events.
Therefore, they conclude in Arthritis Care & Research that “[f]uture studies are required for assessing whether this simple and feasible monitoring method, which patients find easy to use, provides additional value.”
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