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

VL - 47

SP - 809

EP - 819

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

IS - 6

ER -