Is treat-to-target really working in rheumatoid arthritis? a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM) Academic Article uri icon

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abstract

  • ObjectivesTo 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.MethodsRA 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.ResultsIn 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).ConclusionIn daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.

authors

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

publication date

  • April 2020

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