Spring 2019 (Volume 29, Number 1)

Catch Up on the CATCH Cohort’s Successes

By Vivian Bykerk, MD, FRCPC; and Janet Pope, MD, MPH, FRCPC

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The Canadian Early Arthritis Cohort (CATCH) Study is a national initiative that was established in 2007 by investigators with the aim of improving the lives of patients with new-onset rheumatoid arthritis (RA). This is a prospective longitudinal observational cohort study of participants with incident RA who are followed for outcomes of disease activity, symptoms, and other patient-valued measures. Data are captured systematically at specific expected clinical encounters each year (every three months for the first year, every six months in the second year and then annually). The CATCH investigator group, which rapidly grew to up to 22 investigative sites, has in the last 12 years recruited over 3,500 people, and captured data on over 10,000 patient years of follow-up. More than 400 patients have bio banked samples, scored serial radiographs, and 1,000 patients have more than five years of follow-up. The investigators have published more than 40 manuscripts and presented more than 200 abstracts at Canadian and international meetings. In order to share the knowledge gleaned from this study we developed a website for patients and providers (www.earlyarthritis.ca) to learn more about our work.

CATCH rheumatologists aim to meet treatment targets and to increase the number of patients who achieve sustained remission (or, if not possible, low disease activity) by one year (and earlier). Since the Canadian Rheumatology Association (CRA) recommendations in RA were disseminated, we have seen an increase in those who achieve this. Now 60% achieve this target. This, in part, can be attributed to optimized use of medication, and adherence to recommendations. More patients are now using subcutaneous methotrexate or triple therapy as their first therapeutic strategy, which appears to be leading to improved outcomes compared to seven years ago.

CATCH investigators are also focusing their efforts to ensure that more patients have timely access to care. Given the referral process in most provinces it is unusual for patients to be seen before three months of persistent symptoms and the mean persistent symptom duration at study entry is still 5.8 months. Collaborations with external researchers to enhance models of care will include targeting earlier access to care.

Recently the electronic data capture platform has been upgraded allowing easier means to survey patients via mobile devices and to more readily enter clinician-based measures. This has allowed us to integrate the patient voice, capturing RA-related symptoms, mood, adherence, and other quality of life measures at the time of their clinical encounters. For instance, the CATCH patients contributed to validating the flare questionnaire which is now published.

We now have extensive clinical phenotypic data that allows us to examine the patient perspective, perform qualitative studies, and real-world drug evaluation. Investigators have partnered with external research groups including CAN-AIM, a subsidiary of the drug safety and evaluation network (DSEN) of Health Canada (see article in this issue on page 19), the Arthritis Alliance of Canada and the CRA to study the comparative effectiveness and safety and use of medication and models of care. We hope to continue to build partnerships and bridges with other stakeholders to study administrative data and health economics, enabling us to better understand patterns of health and health care in our patients, particularly given the high number of comorbidities in this population. Our goal over time is also to integrate translational studies using collected biological specimens that will allow sequencing studies to look at genetic associations and immunophenotyping.

In the coming year, this valuable national research platform will be the cornerstone of an important Canadian Institutes of Health Research (CIHR)-funded pragmatic trial of treatment tapering guided by both patients and clinicians, with the aim of reducing therapy without causing excessive RA flare. We are also participating in a national initiative to examine the use of biosimilars, and an initiative to study models of care as already mentioned.

In summary, the CATCH study could not be possible without the 3,500 (and growing) patient participants, over 100 rheumatology team members, clinicians, researchers and scientists. This study has been a successful national initiative, funded by multiple stakeholders including pharmaceutical companies and grants, that has grown over 12 years. We anticipate much more can be learned from studying early RA in Canada using the CATCH platform.

Vivian Bykerk, MD, FRCPC
Associate Professor of Medicine,
Weill Cornell Medical College,
Cornell University
Director of the Inflammatory Arthritis Center,
Division of Rheumatology
Hospital for Special Surgery
New York, NY, USA

Janet Pope, MD, MPH, FRCPC
Professor of Medicine,
Division Head,
Division of Rheumatology,
Department of Medicine,
St. Joseph’s Health Care,
Western University
London, Ontario