Long-term outcomes of treat-to-target strategy in established rheumatoid arthritis: a daily practice prospective cohort study

Abstract

To examine disease activity and physical function after implementation of treat-to-target (T2T) strategy in patients with established rheumatoid arthritis (RA) over a long-term period. Patients with RA were started on a T2T strategy in 2005 and followed through 2014. Patients were seen every 3-4 months until remission/low disease activity was achieved and every 6 months thereafter. Disease activity was measured by the DAS28 and CDAI, and physical function by the HAQ-DI. Results were presented as all observed data, without imputation for missing values. Changes in disease activity and physical function were evaluated by generalized estimating equations (GEE). Two hundred and twenty-nine patients were included, with a mean (SD) disease duration of 10.6 (7.4) years. Significant improvements were seen in both composite scores during the follow-up period, as demonstrated by DAS28 (β coefficient = 0.19; 95% CI = 0.16-0.21; p < 0.01) and by CDAI (β coefficient = 1.59; 95% CI = 1.84-1.34; p < 0.01). Physical function also improved, as demonstrated by HAQ-DI (β coefficient = 0.03; 95% CI = 0.02-0.04; p < 0.01). Biological therapy was associated with improvement in disease activity and in physical function. Leflunomide was only associated with improvement in physical function. Clinically meaningful reductions of DAS28, CDAI and HAQ-DI were observed in patients with established rheumatoid arthritis from 2005 to 2014. Implementation of new therapeutic options, in the scenario of T2T strategy, was associated with improvement in disease activity and physical function.

Application of treat-to-target principles in patients with early rheumatoid arthritis in routine clinical practice in Central-Eastern Europe

“…The benefits of a T2T strategy in our study were consistent with those described in the published literature [5,26,30,31]. Disease activity improved continuously during the observation period, as evidenced by increasing proportions of patients in remission (DAS28<2.6) or in remission/low disease activity (DAS28<3.2) at each follow-up visit.…”

Residual symptoms and disease burden among patients with rheumatoid arthritis in remission or low disease activity: a systematic literature review

“…The landscape for the treatment of RA has changed dramatically over the last two decades. The implementation and penetration of the treat to target (T2T) strategy among rheumatologists, which focused on adjusting treatment based on the timeliness of the response in terms of clinical results and achievement of the state of remission or low disease activity (LDA) [2], together with the increasing availability of biologics, has resulted in improvement in reducing disease activity and enhancing patients' physical function [3,4].…”

Superiority of a Treat-to-Target Strategy over Conventional Treatment with Fixed csDMARD and Corticosteroids: A Multi-Center Randomized Controlled Trial in RA Patients with an Inadequate Response to Conventional Synthetic DMARDs, and New Therapy with Certolizumab Pegol

“…Little is known about the response of HAQ-DI in a treat-to-target clinical trial setting. The only publication with a comparable design, where Hirano et al demonstrated a reduction of HAQ-DI from 1.4 to 1.0 when following the Brazilian therapeutic recommendations, had no control group and the observation period was much longer [28]. As a consequence, we did not have any data to calculate the power for significant changes in HAQ-DI for the design of our study.…”