Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM Journal Articles uri icon

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abstract

  • Abstract Objectives To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. Methods Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. Results In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: −0.04, 0.33) for 2 vs 0 visits; and +0.08 units (−0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. Conclusions In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.

authors

  • Ramiro, Sofia
  • Landewé, Robert
  • van der Heijde, Désirée
  • Sepriano, Alexandre
  • FitzGerald, Oliver
  • Østergaard, Mikkel
  • Homik, Joanne
  • Elkayam, Ori
  • Thorne, J Carter
  • Larche, Margaret
  • Ferraccioli, 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
  • van Schaardenburg, Dirkjan
  • Hammer, Hilde B
  • Dadashova, Rana
  • Hutchings, Edna
  • Paschke, Joel
  • Maksymowych, Walter P

publication date

  • September 1, 2023