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Rigshospitalet - a part of Copenhagen University Hospital
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Is treat-to-target really working in rheumatoid arthritis? a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM)

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  • Sofia Ramiro
  • Robert Bm Landewé
  • Désirée van der Heijde
  • Alexandre Sepriano
  • Oliver FitzGerald
  • Mikkel Ostergaard
  • Joanne Homik
  • Ori Elkayam
  • J Carter Thorne
  • Margaret Larche
  • Gianfranco Ferraccioli
  • Marina Backhaus
  • Gilles Boire
  • Bernard Combe
  • Thierry Schaeverbeke
  • Alain Saraux
  • Maxime Dougados
  • Maurizio Rossini
  • Marcello Govoni
  • Luigi Sinigaglia
  • Alain G Cantagrel
  • Cornelia F Allaart
  • Cheryl Barnabe
  • Clifton O Bingham
  • Paul P Tak
  • Dirkjan van Schaardenburg
  • Hilde Berner Hammer
  • Rana Dadashova
  • Edna Hutchings
  • Joel Paschke
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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.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Volume79
Issue number4
Pages (from-to)453-459
Number of pages7
ISSN0003-4967
DOIs
Publication statusPublished - Apr 2020

    Research areas

  • Adult, Aged, Antirheumatic Agents/therapeutic use, Arthritis, Rheumatoid/drug therapy, Blood Sedimentation, C-Reactive Protein/immunology, Clinical Decision-Making, Cohort Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Patient Care Planning, Remission Induction, Rheumatoid Factor/immunology, Tumor Necrosis Factor Inhibitors/therapeutic use, treat-to-target, rheumatoid arthritis, remission

ID: 61745033