Factors influencing use of biologic therapy and adoption of treat-to-target recommendations in current European rheumatology practice

Abstract

ObjectiveThe aim of this study was to identify factors that influence treatment adjustments and adoption of a treat-to-target (T2T) strategy in patients with rheumatoid arthritis (RA) in European practices.MethodsCross-sectional data were drawn from the Adelphi 2014 RA Disease Specific Programme. Treatment patterns and clinical characteristics were investigated in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) vs non-bDMARDs. For the T2T analysis, patients were subdivided into two subsets (RA diagnosis <2 or ≥2 years) and compared according to the approach used (no target = no T2T approach; pragmatic = target different from remission; and aspirational = target set as remission).ResultsData from 2,536 patients were analyzed (mean age: 52.76 years and mean time since RA diagnosis: 6.05 years). Of the 1,438 patients eligible to receive bDMARDs, 55% did not receive them. Initiation of bDMARDs in a bDMARD-naïve patient was prompted by worsening of the disease. In the RA diagnosis <2 years subset, a T2T approach was not adopted in 58% of the patients, whereas 8% and 34% adopted a pragmatic and aspirational approach, respectively. In the RA diagnosis ≥2 years subset, 45%, 19%, and 36% of the patients adopted a no target, pragmatic, and aspirational approach, respectively. Physician satisfaction with RA control was lower in the RA diagnosis <2 years subset than in the RA diagnosis ≥2 years subset (65% vs 77% satisfied, respectively; P<0.0001).ConclusionThis analysis shows that the use of bDMARDs remains suboptimal and that a T2T strategy is not universally adopted.

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

“…A recent systematic report on real-world remission rates under treat-to-target strategy shows an improvement over recent years, although sustained remission is still regarded as rare [13]. Taylor et al provided an analysis of multinational data on RA management, reporting that no T2T approach was present in approximately half of patients, and only close to one third had remission as a chosen target [14]. When examining the subset of patients with RA diagnosis stated within two years, more patients lacked a treatment target, despite 38% of them suffering from moderate to severe RA.…”

Trends in Systemic Glucocorticoid Utilization in the United Kingdom from 1990 to 2019: A Population-Based, Serial Cross-Sectional Analysis

“… 17 , 18 However, there is often a lag between the introduction of new guidelines or therapies and their integration into clinical practice. 19 A longitudinal population-based study of patients with rheumatoid arthritis (RA) showed that initiation of glucocorticoids within 6 months of diagnosis are occurring earlier in their disease compared with prescribing patterns from previous years. 20 Indeed, long-term use of SGC has continued to be observed in conditions with approved and readily available alternatives to steroids, such as severe asthma, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ulcerative colitis (UC).…”