Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort

Alexandre Sepriano, Sofia Ramiro, Oliver FitzGerald, Mikkel Østergaard, Joanne Homik, Désirée van der Heijde, Ori Elkayam, Carter Thorne, Maggie J Larché, Gianfranco Ferraccioli, Marina Backhaus, Gerd R Burmester, Gilles Boire, Bernard Combe, Alain Saraux, Maxime Dougados, Maurizio Rossini, Marcello Govoni, Luigi Sinigaglia, Alain CantagrelCheryl Barnabe, Clifton O Bingham, Paul P Tak, Dirkjan van Schaardenburg, Hilde Berner Hammer, Joel Paschke, Rana Dadashova, Edna Hutchings, Robert Landewé, Walter P Maksymowych

17 Citations (Scopus)


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; NCT01476956].

Original languageEnglish
JournalJournal of Rheumatology
Issue number6
Pages (from-to)809-819
Number of pages11
Publication statusPublished - 1 Jun 2020


  • Best treatment practices
  • Rheumatoid arthritis
  • Treat-to-target


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