Is treat-to-target really working in rheumatoid arthritis? A longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM)
2 Zuyderland Hospital [Heerlen, The Netherlands]
3 Amsterdam UMC - Amsterdam Rheumatology & Immunology Center - ARC [Amsterdam, the Netherlands]
4 NMS - NOVA Medical School - Faculdade de Ciências Médicas
5 St Vincent's University Hospital
6 Center for Rheumatology and Spine Diseases - Copenhagen Center for Arthritis Research,Copenhagen
7 Rigshospitalet [Copenhagen, Denmark]
8 University of Alberta
9 Tel Aviv Sourasky Medical Center [Tel Aviv]
10 University of Toronto
11 McMaster University [Hamilton, Ontario]
12 Unicatt - Università cattolica del Sacro Cuore = Catholic University of the Sacred Heart [Roma]
13 Park-Klinik Weissensee
14 CIUSSS de l'Estrie - CHUS
15 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
16 FHU ACRONIM - Aquitaine’s Care and Research organisation for inflammatory and Immune-Mediated diseases [CHU Bordeaux]
17 CHU - BREST - Rhumato - CHRU Brest - Service de Rhumatologie
18 ECaMO - [CRESS - U1153 / UMR_A 1125] - Clinical Epidemiology Applied to Osteoarticular Diseases | Épidémiologie clinique appliquée aux maladies rhumatismales et musculo-squelettiques
19 UNIVR - Università degli studi di Verona = University of Verona
20 Azienda Ospedaliero-Universitaria Sant'Anna Hospital of Ferrara
21 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO
22 UT3 - Université Toulouse III - Paul Sabatier
23 University of Calgary
24 Johns Hopkins University School of Medicine [Baltimore]
25 Ghent University Hospital
26 CUH - Cambridge University Hospitals - NHS
27 Diakonhjemmet Hospital
28 CaRE Arthritis Ltd
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Résumé
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.