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4. Grigor C, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA Study): a single-blind randomised controlled trial. Lancet. 2004;364:263-269.

5. Rantalaiho V, et al, for the FIN-RACo Trial Group. Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis: the 11-year results of the Finnish Rheumatoid Arthritis Combination Therapy trial. Arthritis Res Ther. 2010;12(3):R122.

6. Verstappen SMM, et al, on behalf of the Utrecht Rheumatoid Arthritis Cohort study group. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis. 2007;66:1443-1449.

7. Goekoop-Ruiterman YPM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52(11):3381-3390.

8. Saag KG, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762-784.

9. Combe B, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34-45.

10. Smolen JS, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631-637.

11. Shen Y, Dirven L. Cavet G, et al. Serum biomarker combinations to assess disease activity in the BeSt study. Presented at: EULAR 2010 Annual European Congress of Rheumatology; June 16-19, 2010: Rome, Italy. Supported by Crescendo Bioscience, Inc.

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35. Ling H, Recklies AD.The chitinase 3-like protein human cartilage glycoprotein 39 inhibits cellular responses to the inflammatory cytokines interleukin-1 and tumour necrosis factor-alpha. Biochem J. 2004;380(pt 3):651-659.

36. Kotzin BL, Falta MT, Crawford F, et al. Use of soluble peptide-DR4 tetramers to detect synovial T cells specific for cartilage antigens in patients with rheumatoid arthritis. Proc Natl Acad Sci USA. 2000;97(1):291-296.

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43. Thommesen L, Stunes AK, Monjo M, et al. Expression and regulation of resistin in osteoblasts and osteoclasts indicate a role in bone metabolism. J Cell Biochem. 2006;99(3):824-834.

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45. Oshima K, Nampei A, Matsuda M, et al. Adiponectin increases bone mass by suppressing osteoclast and activating osteoblast. Biochem Biophys Res Commun. 2005;331(2):520-526.

46. Benigni F, Fantuzzi G, Sacco S, et al. Six different cytokines that share GP130 as a receptor subunit, induce serum amyloid A and potentiate the induction of interleukin-6 and the activation of the hypothalamus-pituitary-adrenal axis by interleukin-1. Blood. 1996;87(5):1851-1854.

47. Zhang N, Ahsan MH, Purchio AF, West DB. Serum amyloid A-luciferase transgenic mice: response to sepsis, acute arthritis, and contact hypersensitivity and the effects of proteasome inhibition. J Immunol. 2005;174(12):8125-8134.

48. Kisilevsky R, Tam SP. Acute phase serum amyloid A, cholesterol metabolism, and cardiovascular disease. Ped Pathol Mol Med. 2002;21(3):291-305.

49. Kumon Y, Suehiro T, Hashimoto K, Nakatani K, Sipe JD. Local expression of acute phase serum amyloid A mRNA in rheumatoid arthritis synovial tissue and cells. J Rheumatol. 1999;26:785.

50. O'Hara R, Murphy EP, Whitehead AS, FitzGerald O, Bresnihan B. Acute-phase serum amyloid A production by rheumatoid arthritis synovial tissue. Arthritis Res. 2000;2:142.

51. Weinhold B, Ruther U. Interleukin-6-dependent and independent regulation of the human C-reactive protein gene. Biochem J. 1997;327:425-429.

52. Zhang D, Jiang SL, Rzewnicki D, Samols D, Kusher I. C-reactive protein expression in Hep3B cells is exerted at the transcriptional level. Biochem J. 1995;310:143-148.

53. Macintyre SS, Schultz D, Kushner I. Biosynthesis of C-reactive protein. Ann NY Acad Sci. 1982;389:76-87.

54. van der Meer IM, Oel HH, Hofman A, Pols HA, de Jong FH, Witteman JC. Soluble Fas, a mediator of apoptosis, C-reactive protein, and coronary and extracoronary atherosclerosis. The Rotterdam Coronary Calcification Study. Atherosclerosis. 2006;189(2):464-469.

55. Knowlton N, et al. Rheumatoid factor interferes with multiplex immunoassays in rheumatoid arthritis patients. Presented at: EULAR 2010 Annual European Congress of Rheumatology; June 16-19, 2010; Rome, Italy.

56. Eastman S, et al. Assay development for precise measurement of disease activity serum biomarkers. Presented at: EULAR 2010 Annual European Congress of Rheumatology; June 16-19, 2010; Rome, Italy.

57. Fleischmann R, et al, on behalf of the InFoRM Study Group. RA population characteristics in InFoRM: a longitudinal observational study. Presented at: EULAR 2010 Annual European Congress of Rheumatology; June 16-19, 2010; Rome, Italy.

58. Ramanujan S, et al. Multi-protein biomarker panel integrates critical pathophysiologic mechanisms in measurement of RA disease activity. Presented at: EULAR 2010 Annual European Congress of Rheumatology; June 16-19, 2010; Rome, Italy.

59. Bakker MF, et al. Performance of serum biomarkers and a pre-specified multivariate biomarker-based test to measure disease activity in early rheumatoid arthritis treated according to the CAMERA protocol. Presented at: EULAR 2010 Annual European Congress of Rheumatology; June 16-19, 2010; Rome, Italy.

60. Curtis JR, et al. Validation of a Multi-Biomarker Test for Rheumatoid Arthritis (RA) Disease Activity (Vectra(TM) DA) in a Multi-Cohort Study. Presentation 1782. ACR/ARHP 2010 Annual Scientific Meeting; November 6-11, 2010. Atlanta, GA, USA.

61. Inoue E, et al. Comparison of Disease Activity Score (DAS)28-erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values. Ann Rheum Dis. 2007;66:407-409.

62. Cavet G, Centola M, Shen Y, et al. Development of a multi-biomarker test for rheumatoid arthritis (RA). Ann Rheum Dis. 2010; 69(suppl 3):148.

References:

1. Grigor C, Capell H, Stirling A, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364:263-269.

2. Rantalaiho V, Korpela M, Laasonen L, et al, for the FIN-RACo Trial Group. Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis: the 11-year results of the Finnish Rheumatoid Arthritis Combination Therapy trial. Arthritis Res Ther. 2010;12(3):R122.

3. Verstappen SMM, Jacobs JWG, van der Veen MJ, et al. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis. 2007;66:1443-1449.

4. Goekoop-Ruiterman YPM, De Vries-Bouwstra JK, Allaart CF, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2005;52:3381-3390.

5. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762-784.

6. Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34-45.

7. Smolen JS, Aletaha D, Bijlsma JWJ, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631-637.

8. Barton JL, Imboden J, Graf J, et al. Patient-physician discordance in assessments of global disease severity in rheumatoid arthritis. Arthritis Care Res. 2010;62:857-864.

9. Sokka T, Pincus T. Erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor are normal at presentation in 35%–45% of patients with rheumatoid arthritis seen between 1980 and 2004: analyses from Finland and the United States. J Rheumatol. 2009;36:1387-1390.

10. Brown AK, Conaghan PG, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum. 2008;58:2958-2967.

11. Garnero P, Geusens P, Landewé R. Biochemical markers of joint tissue turnover in early rheumatoid arthritis. Clin Exp Rheumatol. 2003:21(suppl 31):S54-S58.

12. Shen Y, Cavet G, Dirven L, et al. Discovery of serum biomarker combinations to assess disease activity in the BeSt study. Ann Rheum Dis. 2010;69(suppl 3):674.

13. Curtis JR, van der Helm-van Mil AH, Knevel R, et al. Validation of a novel multi-biomarker test to assess rheumatoid arthritis disease activity. Arthritis Care Res. 2012; doi:10.1002/acr.21767 [Epub ahead of print].

14. Inoue E, Yamanaka H, Hara M, et al. Comparison of Disease Activity Score (DAS)28-erythrocyte sedimentation rate and DAS28- C-reactive protein threshold values. Ann Rheum Dis. 2007;66:407-409.

15. Data on file, Crescendo Bioscience.

16. Hirata S, Dirven L, Cavet G, et al. A Novel Multi-Biomarker Disease Activity Score (Vectra DA algorithm score) Reflects Clinical Disease Activity Score and Health Assessment Questionnaire for Rheumatoid Arthritis in the BeSt Study. Poster 351. ACR 2011 Annual Scientific Meeting. Chicago, IL.

17. Weinblatt ME, Shadick NA, Manning W, et al. Use of a multi-biomarker score for rheumatoid arthritis disease activity (VectraTM DA) to assess response to therapy. Ann Rheum Dis. 2011;70(suppl 3):290.

18. Shadick NA, Chernoff D, Hamburger M, et al. Robustness of a novel multi-biomarker score for RA disease activity (VectraTM DA) across a spectrum of co-morbidities and smoking status. Ann Rheum Dis. 2011;70(suppl 3):446.

19. van der Helm-van Mil AHM, Knevel R, Qureshi F, et al. Evaluation of definitions of rheumatoid arthritis remission by assessing radiographic progression in the Leiden early arthritis cohort. Ann Rheum Dis. 2012;71(suppl 3):497.

20. Ma MH, Ramanujan S, Haney DJ et al. Biomarker signatures in rheumatoid arthritis patients with low disease activity: the REMIRA study. Ann Rheum Dis. 2011;70(suppl 3):537.

21. Allaart CF, Dirven L, Hirata S, et al. A multi-biomarker disease activity score predicts radiographic progression in the BeSt Study. Arthritis Rheum. 2011;63(suppl 10):S630.

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Frequently asked questions

Can I use Vectra DA to confirm a diagnosis of RA?

Vectra DA is not intended or validated for the diagnosis or confirmation of RA.

Which of my RA patients may benefit from Vectra DA?

Vectra DA can be used in any adult patient with RA. Test results are intended to aid in the assessment of disease activity in RA patients when used in conjunction with standard clinical assessment. This test is not intended or validated to diagnose RA.

How often should I order Vectra DA for each of my patients?

Vectra DA can be considered anytime you assess disease activity. The frequency of the assessment, therefore, may vary for each patient and each physician.

How is Vectra DA different than CRP testing?

Vectra DA simultaneously measures 12 key proteins (including CRP) that are consistently associated with RA disease activity. In contrast, CRP is a single biomarker. Multivariate regression indicates that Vectra DA is an independent predictor of DAS28CRP, even after adjusting for CRP (P<0.001).

How should I interpret Vectra DA test scores?

Vectra DA scores >44 correspond to high disease activity, scores >29 but ≤44 correspond to moderate disease activity, and scores 1 to ≤29 correspond to low disease activity. The disease activity thresholds shown reflect the Vectra DA score equivalent to DAS28CRP cut-offs of 2.67 (low to moderate) and 4.09 (moderate to high), respectively (Inoue et al. Ann Rheum Dis. 2007;66:407-409), and were calculated by converting the DAS28 scale (0-9.4) to the Vectra DA scale (1 to 100).67

These thresholds are provided as a guide and a complement to your clinical judgment to help inform patient management. If you have questions or would like assistance in interpreting a Vectra DA result, please contact Crescendo Bioscience at 1-877-RHEUMDX (1-877-743-8639) or medicalaffairs@crescendobio.com.

How reliable are the results of Vectra DA?

Vectra DA was validated in adults diagnosed with RA. The Vectra DA score was significantly associated with disease activity categories based on DAS28CRP† (P<0.001) in both a study of adults positive for RF and/or anti-CCP* and a separate study of adults who tested negative for RF and anti-CCP antibodies.*60 In 230 adults with RF+ and/or anti-CCP+ RA,* the area under the receiver operating characteristic (AUROC) curve was 0.77† and Pearson correlation was 0.56.60 In 141 adults who tested negative for both RF and anti-CCP antibodies,** the area under the receiver operating characteristic (AUROC) curve was 0.70.† and Pearson correlation was 0.43.60

† Based on a DAS28CRP cutoff of 2.67 as previously determined by Inoue, et al.61
* Patients were selected with the objective of achieving a uniform distribution of disease activity.
** Patients were selected with the objective of a disease activity distribution representative of the cohorts from which they were selected.

How was Vectra DA developed and validated?

Vectra DA was developed using a broad survey of RA biology, with serial studies to determine a final assay composed of biomarkers that robustly assess disease activity. Approximately 400 candidate biomarkers were chosen from an extensive screen of literature, databases, and experimental data that included gene expression, protein arrays, and biological pathways. Of those, 130 candidates were screened in clinical studies. Successive studies in >1,300 total patients with RA refined the biomarker set to those 12 with the greatest ability to evaluate RA disease activity, based on association with clinical measures including the DAS28CRP. A statistical algorithm was developed that used the biomarker levels to calculate a disease activity score. Evaluation of the algorithm in an independent patient cohort validated its ability to quantify RA disease activity.

Will health insurance cover testing with Vectra DA?

Until each insurance company provides a positive coverage statement, we will not know for sure if it will be covered by that insurance company. Insurance companies may still pay for the test without a formal coverage policy. If one of your patients should face a challenge with reimbursement, we offer comprehensive reimbursement services through the Crescendo Access & Reimbursement Essentials (CARE) program to meet the needs of each patient.

Our experienced reimbursement specialists are available from
7 am to 4 pm PST, Monday through Friday, to answer any questions from you, your staff, or your patients. Simply call 1-877-RHEUMDX (1-877-743-8639).

Does Crescendo Bioscience provide financial assistance?

Crescendo provides financial assistance programs for uninsured and underinsured patients through the Crescendo Access & Reimbursement Essentials (CARE) program. For patients who have no insurance or have insurance that does not cover the test, Vectra DA may be provided at no cost based on financial eligibility. For those who have insurance* and cannot afford the out-of-pocket costs, financial assistance may also be available.

*Not valid for services reimbursed under Medicare, Medicaid, or similar federal or state programs.

Before or after receiving Vectra DA, patients can contact Crescendo to see if they qualify for financial assistance. Crescendo will mail or fax the CARE financial assistance application form or it can be downloaded here.

How do I order a Vectra DA test?

Vectra DA specimen collection kits, which can be ordered through Customer Service or your local Crescendo Representative, include everything needed to order a test, collect a blood specimen, and send the specimen to our CLIA laboratory for processing. Included in the kit is information on sample collection and shipping. Specimens for up to 3 patients can be shipped in each Vectra DA kit. Customer Service can be reached toll-free at 1-877-RHEUMDX (1-877-743-8639) or customerservice@crescendobio.com.

How do I receive the results of a Vectra DA test?

Vectra DA test reports are available via fax or mail, or through the VectraView portal, based on your preference. Results are available approximately 7 to 10 business days after the specimen is received at Crescendo. The report provides the Vectra DA score and score history, which can be used to enhance patient counseling.

What are the benefits of using the VectraView online portal?

VectraView is a secure, user-friendly online portal for both physicians and office staff. It provides health care professionals with a simple, seamless way to order Vectra DA tests, track the status of a test order, review Vectra DA test results, and follow patient medication use. The system also allows physicians to delegate access to the VectraView portal to their staff.

Should I order Vectra DA before or after a scheduled appointment?

Vectra DA can be a valuable complement to your clinical judgment in the tracking of RA disease activity, whether ordered before or after a scheduled appointment. Vectra DA may be most valuable when current test results are available at the time of each patient visit. If you would like to have the results available at the time of the scheduled office visit, patients should have blood drawn for Vectra DA at least 2 weeks prior to the visit.

What laboratories are contracted to perform Vectra DA tests?

Crescendo has a California-licensed CLIA-certified laboratory dedicated to testing blood specimens for the Vectra DA test, with results reported in approximately 7 to 10 business days. Vectra DA is only available from Crescendo's Clinical Laboratory.

Can results of the test be sent directly to my patients?

Physicians will receive Vectra DA test reports via fax or mail, or through the VectraView portal approximately 7 to 10 business days after the specimen is received. Physicians can send results of the Vectra DA test to their patients before an office visit if they choose, but Crescendo will report results only to the ordering physician (or authorized delegate).


Learn more about Using Vectra DA in conjunction with Clinical Assessment

Learn more about the biomarkers in Vectra DA by clicking here.