TY - JOUR
T1 - Is treat-to-target really working in rheumatoid arthritis?
T2 - a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM)
AU - Ramiro, Sofia
AU - Landewé, Robert Bm
AU - van der Heijde, Désirée
AU - Sepriano, Alexandre
AU - FitzGerald, Oliver
AU - Ostergaard, Mikkel
AU - Homik, Joanne
AU - Elkayam, Ori
AU - Thorne, J Carter
AU - Larche, Margaret
AU - Ferraccioli, Gianfranco
AU - Backhaus, Marina
AU - Boire, Gilles
AU - Combe, Bernard
AU - Schaeverbeke, Thierry
AU - Saraux, Alain
AU - Dougados, Maxime
AU - Rossini, Maurizio
AU - Govoni, Marcello
AU - Sinigaglia, Luigi
AU - Cantagrel, Alain G
AU - Allaart, Cornelia F
AU - Barnabe, Cheryl
AU - Bingham, Clifton O
AU - Tak, Paul P
AU - van Schaardenburg, Dirkjan
AU - Hammer, Hilde Berner
AU - Dadashova, Rana
AU - Hutchings, Edna
AU - Paschke, Joel
N1 - COPECARE
PY - 2020/4
Y1 - 2020/4
N2 - OBJECTIVES: To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target.METHODS: RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models.RESULTS: In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52).CONCLUSION: In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.
AB - OBJECTIVES: To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target.METHODS: RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models.RESULTS: In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52).CONCLUSION: In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.
KW - Adult
KW - Aged
KW - Antirheumatic Agents/therapeutic use
KW - Arthritis, Rheumatoid/drug therapy
KW - Blood Sedimentation
KW - C-Reactive Protein/immunology
KW - Clinical Decision-Making
KW - Cohort Studies
KW - Female
KW - Humans
KW - Longitudinal Studies
KW - Male
KW - Middle Aged
KW - Patient Care Planning
KW - Remission Induction
KW - Rheumatoid Factor/immunology
KW - Tumor Necrosis Factor Inhibitors/therapeutic use
KW - treat-to-target
KW - rheumatoid arthritis
KW - remission
U2 - 10.1136/annrheumdis-2019-216819
DO - 10.1136/annrheumdis-2019-216819
M3 - Journal article
C2 - 32094157
SN - 0003-4967
VL - 79
SP - 453
EP - 459
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 4
ER -