Precision Medicine Approach to Develop and Internally Validate Optimal Exercise and Weight-Loss Treatments for Overweight and Obese Adults With Knee Osteoarthritis: Data From a Single-Center Randomized Trial.

TitlePrecision Medicine Approach to Develop and Internally Validate Optimal Exercise and Weight-Loss Treatments for Overweight and Obese Adults With Knee Osteoarthritis: Data From a Single-Center Randomized Trial.
Publication TypeJournal Article
Year of Publication2021
AuthorsJiang, Xiaotong, Amanda E. Nelson, Rebecca J. Cleveland, Daniel P. Beavers, Todd A. Schwartz, Liubov Arbeeva, Carolina Alvarez, Leigh F. Callahan, Stephen Messier, Richard Loeser, and Michael R. Kosorok
JournalArthritis Care Res (Hoboken)
Volume73
Issue5
Pagination693-701
Date Published2021 05
ISSN2151-4658
KeywordsAged, Caloric Restriction, Clinical Decision Rules, Clinical Decision-Making, Exercise Therapy, Female, Humans, Knee Joint, Machine Learning, Male, Middle Aged, Obesity, Osteoarthritis, Knee, Precision Medicine, Predictive Value of Tests, Reproducibility of Results, Time Factors, Treatment Outcome, Weight Loss
Abstract

OBJECTIVE: To apply a precision medicine approach to determine the optimal treatment regime for participants in an exercise (E), dietary weight loss (D), and D + E trial for knee osteoarthritis that would maximize their expected outcomes.METHODS: Using data from 343 participants of the Intensive Diet and Exercise for Arthritis (IDEA) trial, we applied 24 machine-learning models to develop individualized treatment rules on 7 outcomes: Short Form 36 physical component score, weight loss, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain/function/stiffness scores, compressive force, and interleukin-6 level. The optimal model was selected based on jackknife value function estimates that indicate improvement in the outcomes if future participants follow the estimated decision rule compared to the optimal single, fixed treatment model.RESULTS: Multiple outcome random forest was the optimal model for the WOMAC outcomes. For the other outcomes, list-based models were optimal. For example, the estimated optimal decision rule for weight loss indicated assigning the D + E intervention to participants with baseline weight not exceeding 109.35 kg and waist circumference above 90.25 cm, and assigning D to all other participants except those with a history of a heart attack. If applied to future participants, the optimal rule for weight loss is estimated to increase average weight loss to 11.2 kg at 18 months, contrasted with 9.8 kg if all participants received D + E (P = 0.01).CONCLUSION: The precision medicine models supported the overall findings from IDEA that the D + E intervention was optimal for most participants, but there was evidence that a subgroup of participants would likely benefit more from diet alone for 2 outcomes.

DOI10.1002/acr.24179
Alternate JournalArthritis Care Res (Hoboken)
Original PublicationA precision medicine approach to develop and internally validate optimal exercise and weight loss treatments for overweight and obese adults with knee osteoarthritis.
PubMed ID32144896
PubMed Central IDPMC7483572
Grant ListUL1 TR002489 / TR / NCATS NIH HHS / United States
P60 AR064166 / AR / NIAMS NIH HHS / United States
P01 CA142538 / CA / NCI NIH HHS / United States
R01 AR052528 / AR / NIAMS NIH HHS / United States
P30 AR072580 / AR / NIAMS NIH HHS / United States