Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials: a GRAPPA-OMERACT systematic review and network meta-analysis

Tommy K Annfeldt; Mina N Händel; Tobias Haugegaard; Marius Henriksen; Laura C Coates; Alexis Ogdie; William Tillett; Niti Goel; Dafna D Gladman; Ana-Maria Orbai; Maarten de Wit; Vibeke Strand; Philip J Mease; Oliver FitzGerald; Philip S Helliwell; Peter Tugwell; Ying-Ying Leung; Robin Christensen

doi:10.1016/j.ard.2026.05.013

Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials: a GRAPPA-OMERACT systematic review and network meta-analysis

Tommy K Annfeldt
, Mina N Händel
, Tobias Haugegaard
, Marius Henriksen
, Laura C Coates
, Alexis Ogdie
, William Tillett
, Niti Goel
, Dafna D Gladman
, Ana-Maria Orbai
, Maarten de Wit
, Vibeke Strand
, Philip J Mease
, Oliver FitzGerald
, Philip S Helliwell
, Peter Tugwell
, Ying-Ying Leung
, Robin Christensen

Copenhagen University Hospital at Bispebjerg and Frederiksberg
University of Southern Denmark
Odense University Hospital
University of Oxford
University of Pennsylvania
Duke University School of Medicine
University of Toronto
Johns Hopkins University School of Medicine
GRAPPA Patient Research Partner
Stanford University
University of Washington
University College Dublin
University of Leeds
University of Ottawa
Duke-NUS Medical School Singapore

Research output: Contribution to journal › Article › peer-review

1 Citation (SciVal)

Abstract

OBJECTIVES: To identify which composite outcome measure most effectively distinguishes active treatments from placebo in randomised controlled trials (RCTs) of biologic or targeted synthetic disease-modifying antirheumatic drugs (b- or tsDMARDs) for psoriatic arthritis (PsA).

METHODS: A systematic literature review (PROSPERO ID: CRD42024578203) of Cochrane Central Register of Controlled Trials and PubMed identified RCTs comparing b- or tsDMARDs with placebo reporting ≥2 of 7 composite outcome measures shortlisted for evaluation by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology (GRAPPA-OMERACT) working group (American College of Rheumatology Response Criteria [ACR], Composite Psoriatic Disease Activity Index [CPDAI], Disease Activity index for PSoriatic Arthritis [DAPSA], Minimal Disease Activity [MDA], Psoriatic Arthritis Disease Activity Score [PASDAS], and 3- and 4-Visual Analogue Scale [VAS]). Discriminant capacities were assessed using odds ratio (OR) for binary outcomes, with continuous outcomes converted from standardised mean differences and analysed through network and multivariate meta-analysis techniques.

RESULTS: Of 2483 references, 24 trials were included (43 randomised comparisons). CPDAI was rarely reported, and no RCTs reported 3-VAS and 4-VAS. The main network meta-analysis showed differences in discriminant properties for DAPSA vs ACR20 (OR: 0.80; 95% CI: 0.66-0.97; favouring ACR20), DAPSA vs MDA (OR: 0.71; 0.57-0.87; favouring MDA), and PASDAS vs DAPSA (OR: 1.35; 1.10-1.66; favouring PASDAS). Supported by multivariate meta-analysis: MDA (OR: 5.06; 4.20-6.09), ACR20 (OR: 4.01; 3.41-4.73), PASDAS (OR:3.70; 3.00-4.56), DAPSA (OR: 3.02; 2.44-3.75), and CPDAI (OR: 1.86; 0.95-3.64). Sensitivity analyses confirmed a pattern of consistent numerical advantages for MDA and PASDAS. Exploratory analyses showed ACR70 had more discriminant capacity than ACR20 and DAPSA but not ACR50, MDA, and PASDAS.

CONCLUSIONS: ACR20, MDA, and PASDAS demonstrated greater discriminant capacity than DAPSA. Exploratory analyses suggested greater discriminant capacity for ACR70 compared with ACR20 and DAPSA but not with ACR50, MDA or PASDAS.

Original language	English
Number of pages	13
Journal	Annals of the Rheumatic Diseases
Early online date	4 Jun 2026
DOIs	https://doi.org/10.1016/j.ard.2026.05.013
Publication status	E-pub ahead of print - 4 Jun 2026

Bibliographical note

Acknowledgements

We thank the Parker Institute, Bispebjerg and Frederiksberg Hospital, and the OMERACT Technical Advisory Group (TAG) for their guidance.

Funding

The Parker Institute, Bispebjerg and Frederiksberg Hospital is supported by a core grant from the Oak Foundation (OCAY-24-074-OFIL). This research was carried out on behalf of the OMER-ACT Technical Advisory Group which had no role in study design, data collection, data synthesis, data interpretation, and writing the report or the decision to submit the manuscript for publication. Apart from above, this research project received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

Access to Document

10.1016/j.ard.2026.05.013Licence: CC BY

Cite this

Annfeldt, T. K., Händel, M. N., Haugegaard, T., Henriksen, M., Coates, L. C., Ogdie, A., Tillett, W., Goel, N., Gladman, D. D., Orbai, A.-M., de Wit, M., Strand, V., Mease, P. J., FitzGerald, O., Helliwell, P. S., Tugwell, P., Leung, Y.-Y., & Christensen, R. (2026). Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials: a GRAPPA-OMERACT systematic review and network meta-analysis. Annals of the Rheumatic Diseases. Advance online publication. https://doi.org/10.1016/j.ard.2026.05.013

Annfeldt, TK, Händel, MN, Haugegaard, T, Henriksen, M, Coates, LC, Ogdie, A, Tillett, W, Goel, N, Gladman, DD, Orbai, A-M, de Wit, M, Strand, V, Mease, PJ, FitzGerald, O, Helliwell, PS, Tugwell, P, Leung, Y-Y & Christensen, R 2026, 'Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials: a GRAPPA-OMERACT systematic review and network meta-analysis', Annals of the Rheumatic Diseases. https://doi.org/10.1016/j.ard.2026.05.013

@article{f87d300929294377bc04468f56dcd295,

title = "Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials: a GRAPPA-OMERACT systematic review and network meta-analysis",

abstract = "OBJECTIVES: To identify which composite outcome measure most effectively distinguishes active treatments from placebo in randomised controlled trials (RCTs) of biologic or targeted synthetic disease-modifying antirheumatic drugs (b- or tsDMARDs) for psoriatic arthritis (PsA).METHODS: A systematic literature review (PROSPERO ID: CRD42024578203) of Cochrane Central Register of Controlled Trials and PubMed identified RCTs comparing b- or tsDMARDs with placebo reporting ≥2 of 7 composite outcome measures shortlisted for evaluation by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology (GRAPPA-OMERACT) working group (American College of Rheumatology Response Criteria [ACR], Composite Psoriatic Disease Activity Index [CPDAI], Disease Activity index for PSoriatic Arthritis [DAPSA], Minimal Disease Activity [MDA], Psoriatic Arthritis Disease Activity Score [PASDAS], and 3- and 4-Visual Analogue Scale [VAS]). Discriminant capacities were assessed using odds ratio (OR) for binary outcomes, with continuous outcomes converted from standardised mean differences and analysed through network and multivariate meta-analysis techniques.RESULTS: Of 2483 references, 24 trials were included (43 randomised comparisons). CPDAI was rarely reported, and no RCTs reported 3-VAS and 4-VAS. The main network meta-analysis showed differences in discriminant properties for DAPSA vs ACR20 (OR: 0.80; 95\% CI: 0.66-0.97; favouring ACR20), DAPSA vs MDA (OR: 0.71; 0.57-0.87; favouring MDA), and PASDAS vs DAPSA (OR: 1.35; 1.10-1.66; favouring PASDAS). Supported by multivariate meta-analysis: MDA (OR: 5.06; 4.20-6.09), ACR20 (OR: 4.01; 3.41-4.73), PASDAS (OR:3.70; 3.00-4.56), DAPSA (OR: 3.02; 2.44-3.75), and CPDAI (OR: 1.86; 0.95-3.64). Sensitivity analyses confirmed a pattern of consistent numerical advantages for MDA and PASDAS. Exploratory analyses showed ACR70 had more discriminant capacity than ACR20 and DAPSA but not ACR50, MDA, and PASDAS.CONCLUSIONS: ACR20, MDA, and PASDAS demonstrated greater discriminant capacity than DAPSA. Exploratory analyses suggested greater discriminant capacity for ACR70 compared with ACR20 and DAPSA but not with ACR50, MDA or PASDAS.",

author = "Annfeldt, \{Tommy K\} and H{\"a}ndel, \{Mina N\} and Tobias Haugegaard and Marius Henriksen and Coates, \{Laura C\} and Alexis Ogdie and William Tillett and Niti Goel and Gladman, \{Dafna D\} and Ana-Maria Orbai and \{de Wit\}, Maarten and Vibeke Strand and Mease, \{Philip J\} and Oliver FitzGerald and Helliwell, \{Philip S\} and Peter Tugwell and Ying-Ying Leung and Robin Christensen",

year = "2026",

month = jun,

day = "4",

doi = "10.1016/j.ard.2026.05.013",

language = "English",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials

T2 - a GRAPPA-OMERACT systematic review and network meta-analysis

AU - Annfeldt, Tommy K

AU - Händel, Mina N

AU - Haugegaard, Tobias

AU - Henriksen, Marius

AU - Coates, Laura C

AU - Ogdie, Alexis

AU - Tillett, William

AU - Goel, Niti

AU - Gladman, Dafna D

AU - Orbai, Ana-Maria

AU - de Wit, Maarten

AU - Strand, Vibeke

AU - Mease, Philip J

AU - FitzGerald, Oliver

AU - Helliwell, Philip S

AU - Tugwell, Peter

AU - Leung, Ying-Ying

AU - Christensen, Robin

PY - 2026/6/4

Y1 - 2026/6/4

N2 - OBJECTIVES: To identify which composite outcome measure most effectively distinguishes active treatments from placebo in randomised controlled trials (RCTs) of biologic or targeted synthetic disease-modifying antirheumatic drugs (b- or tsDMARDs) for psoriatic arthritis (PsA).METHODS: A systematic literature review (PROSPERO ID: CRD42024578203) of Cochrane Central Register of Controlled Trials and PubMed identified RCTs comparing b- or tsDMARDs with placebo reporting ≥2 of 7 composite outcome measures shortlisted for evaluation by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology (GRAPPA-OMERACT) working group (American College of Rheumatology Response Criteria [ACR], Composite Psoriatic Disease Activity Index [CPDAI], Disease Activity index for PSoriatic Arthritis [DAPSA], Minimal Disease Activity [MDA], Psoriatic Arthritis Disease Activity Score [PASDAS], and 3- and 4-Visual Analogue Scale [VAS]). Discriminant capacities were assessed using odds ratio (OR) for binary outcomes, with continuous outcomes converted from standardised mean differences and analysed through network and multivariate meta-analysis techniques.RESULTS: Of 2483 references, 24 trials were included (43 randomised comparisons). CPDAI was rarely reported, and no RCTs reported 3-VAS and 4-VAS. The main network meta-analysis showed differences in discriminant properties for DAPSA vs ACR20 (OR: 0.80; 95% CI: 0.66-0.97; favouring ACR20), DAPSA vs MDA (OR: 0.71; 0.57-0.87; favouring MDA), and PASDAS vs DAPSA (OR: 1.35; 1.10-1.66; favouring PASDAS). Supported by multivariate meta-analysis: MDA (OR: 5.06; 4.20-6.09), ACR20 (OR: 4.01; 3.41-4.73), PASDAS (OR:3.70; 3.00-4.56), DAPSA (OR: 3.02; 2.44-3.75), and CPDAI (OR: 1.86; 0.95-3.64). Sensitivity analyses confirmed a pattern of consistent numerical advantages for MDA and PASDAS. Exploratory analyses showed ACR70 had more discriminant capacity than ACR20 and DAPSA but not ACR50, MDA, and PASDAS.CONCLUSIONS: ACR20, MDA, and PASDAS demonstrated greater discriminant capacity than DAPSA. Exploratory analyses suggested greater discriminant capacity for ACR70 compared with ACR20 and DAPSA but not with ACR50, MDA or PASDAS.

AB - OBJECTIVES: To identify which composite outcome measure most effectively distinguishes active treatments from placebo in randomised controlled trials (RCTs) of biologic or targeted synthetic disease-modifying antirheumatic drugs (b- or tsDMARDs) for psoriatic arthritis (PsA).METHODS: A systematic literature review (PROSPERO ID: CRD42024578203) of Cochrane Central Register of Controlled Trials and PubMed identified RCTs comparing b- or tsDMARDs with placebo reporting ≥2 of 7 composite outcome measures shortlisted for evaluation by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology (GRAPPA-OMERACT) working group (American College of Rheumatology Response Criteria [ACR], Composite Psoriatic Disease Activity Index [CPDAI], Disease Activity index for PSoriatic Arthritis [DAPSA], Minimal Disease Activity [MDA], Psoriatic Arthritis Disease Activity Score [PASDAS], and 3- and 4-Visual Analogue Scale [VAS]). Discriminant capacities were assessed using odds ratio (OR) for binary outcomes, with continuous outcomes converted from standardised mean differences and analysed through network and multivariate meta-analysis techniques.RESULTS: Of 2483 references, 24 trials were included (43 randomised comparisons). CPDAI was rarely reported, and no RCTs reported 3-VAS and 4-VAS. The main network meta-analysis showed differences in discriminant properties for DAPSA vs ACR20 (OR: 0.80; 95% CI: 0.66-0.97; favouring ACR20), DAPSA vs MDA (OR: 0.71; 0.57-0.87; favouring MDA), and PASDAS vs DAPSA (OR: 1.35; 1.10-1.66; favouring PASDAS). Supported by multivariate meta-analysis: MDA (OR: 5.06; 4.20-6.09), ACR20 (OR: 4.01; 3.41-4.73), PASDAS (OR:3.70; 3.00-4.56), DAPSA (OR: 3.02; 2.44-3.75), and CPDAI (OR: 1.86; 0.95-3.64). Sensitivity analyses confirmed a pattern of consistent numerical advantages for MDA and PASDAS. Exploratory analyses showed ACR70 had more discriminant capacity than ACR20 and DAPSA but not ACR50, MDA, and PASDAS.CONCLUSIONS: ACR20, MDA, and PASDAS demonstrated greater discriminant capacity than DAPSA. Exploratory analyses suggested greater discriminant capacity for ACR70 compared with ACR20 and DAPSA but not with ACR50, MDA or PASDAS.

UR - https://www.scopus.com/pages/publications/105041120437

U2 - 10.1016/j.ard.2026.05.013

DO - 10.1016/j.ard.2026.05.013

M3 - Article

C2 - 42248769

SN - 0003-4967

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

ER -

Composite outcome measures that successfully differentiate active treatments from placebo in psoriatic arthritis trials: a GRAPPA-OMERACT systematic review and network meta-analysis

Abstract

Bibliographical note

Acknowledgements

Funding

Access to Document

Other files and links

Fingerprint

Cite this