TY - JOUR
T1 - Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors
T2 - Data from the International RA BIODAM Cohort
AU - Sepriano, Alexandre
AU - Ramiro, Sofia
AU - FitzGerald, Oliver
AU - Østergaard, Mikkel
AU - Homik, Joanne
AU - van der Heijde, Désirée
AU - Elkayam, Ori
AU - Thorne, Carter
AU - Larché, Maggie J
AU - Ferraccioli, Gianfranco
AU - Backhaus, Marina
AU - Burmester, Gerd R
AU - Boire, Gilles
AU - Combe, Bernard
AU - Saraux, Alain
AU - Dougados, Maxime
AU - Rossini, Maurizio
AU - Govoni, Marcello
AU - Sinigaglia, Luigi
AU - Cantagrel, Alain
AU - Barnabe, Cheryl
AU - Bingham, Clifton O
AU - Tak, Paul P
AU - van Schaardenburg, Dirkjan
AU - Hammer, Hilde Berner
AU - Paschke, Joel
AU - Dadashova, Rana
AU - Hutchings, Edna
AU - Landewé, Robert
AU - Maksymowych, Walter P
N1 - COPECARE
PY - 2020/6/1
Y1 - 2020/6/1
N2 - OBJECTIVE: Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T.METHODS: Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model).RESULTS: A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02-1.19), smoking (OR 1.32, 95% CI 1.08-1.63) and high number of tender joints (OR 1.03, 95% CI 1.02-1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50-0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model.CONCLUSION: Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].
AB - OBJECTIVE: Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T.METHODS: Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model).RESULTS: A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02-1.19), smoking (OR 1.32, 95% CI 1.08-1.63) and high number of tender joints (OR 1.03, 95% CI 1.02-1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50-0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model.CONCLUSION: Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].
KW - Best treatment practices
KW - Rheumatoid arthritis
KW - Treat-to-target
UR - http://www.scopus.com/inward/record.url?scp=85085903940&partnerID=8YFLogxK
U2 - 10.3899/jrheum.190303
DO - 10.3899/jrheum.190303
M3 - Journal article
C2 - 31523049
SN - 0315-162X
VL - 47
SP - 809
EP - 819
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 6
ER -