Treat to target strategy in early rheumatoid arthritis versus routine care – A comparative clinical practice study

Brinkmann, Gina Hetland; Norvang, Vibeke; Norli, Ellen Sauar; Grøvle, Lars; Haugen, Anne Julsrud; Lexberg, Åse Stavland; Rødevand, Erik; Bakland, Gunnstein; Nygaard, Halvor; Krøll, Frode; Widding‐Hansen, Inger Johanne; Bjørneboe, Olav; Thunem, Cathrine; Kvien, Tore K; Mjaavatten, Maria D; Lie, Elisabeth

doi:10.1016/j.semarthrit.2018.07.004

Cited by 34 publications

(29 citation statements)

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“…The first cohort studies focussed on patients with very early disease and confirmed that following a standardised intensive treatment led to improved achievement of remission 10. Subsequently, some cohort studies have shown that tight-control treatment leads to more rapid remission and higher remission achievement after 1 or 2 years than usual care 11 12. Nevertheless, the conclusions from these two studies were based on an indirect comparison between two different cohorts (one with T2T applied and another with usual care), with different patient characteristics, and focussed on the remission achievement at 1 or 2 years in the two cohorts.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Clinical trials have provided consistent evidence that this so-called treat-to-target (T2T) strategy results in superior clinical outcomes compared with routine care and enhances long-term functional and quality of life outcomes [2,3]. More recently, observational cohort studies have demonstrated that implementation of T2T is also realistic in daily clinical practice [4][5][6] and results in improved short-and long-term outcomes, similar to those found in clinical trials [7].…”

Section: Introductionmentioning

confidence: 84%

Long-term clinical, functional, and cost outcomes for early rheumatoid arthritis patients who did or did not achieve early remission in a real-world treat-to-target strategy

et al. 2019

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Objective To retrospectively compare the long-term clinical, functional, and cost outcomes for early RA patients (symptoms < 1 year) who did or did not achieve early remission in a treat-to-target strategy. Method Five-year data of 471 patients included in the DREAM remission induction cohort were used. Patients were treated according to a pre-specified 28-joint Disease Activity Score (DAS28) remission driven step-up treatment strategy starting with methotrexate, addition of sulfasalazine, and exchange of sulfasalazine for biological medication in case of failure. Two-and 3year healthcare costs were available for selected subsamples of patients only. Results DAS28 remission was achieved in 27.7%, 38.2%, and 51.6% of patients at 2, 3, and 6 months, respectively. Achieving DAS28 remission at 2, 3, or 6 months was consistently associated with significantly lower DAS28 and Health Assessment Questionnaire-Disability scores at 1, 3, and 5 years of follow-up (all P values < 0.02). Patients in remission at 2, 3, or 6 months also had significantly lower medication costs per patient over the first 2 and 3 years of treatment, mainly due to lower biologic use, but differences in total healthcare resource costs (hospital admissions plus consultations) were less pronounced. Mean total medication and total healthcare resource costs at 3 years were €1131 and €1757 for patients in remission at 6 months vs. €7533 (P < 0.01) and €2202 (P = 0.09) for those not in remission. Conclusion Achieving early remission was associated with beneficial clinical outcomes for early RA patients and lower costs in the long term. Key Points • Previous studies in rheumatoid arthritis patients have demonstrated that early good response is associated with sustained remission and better long-term clinical outcomes. • This study extents these findings by examining the long-term benefits of achieving early remission on clinical, patient-reported, and economic outcomes in a real-world cohort of patients with very early rheumatoid arthritis treated according to treat-to-target principles. • The findings of this study clearly demonstrate that aiming for early remission in rheumatoid arthritis patients is beneficial in the long-term in terms of better clinical and functional outcomes and lower healthcare costs

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“…This result is very similar to the OR obtained in our study, though we evaluated achievement of LDA/REM instead. In another similar study, Norwegian authors compared patients following a T2T strategy (2010-2015) with patients from the pre-T2T cohort (2006)(2007)(2008)(2009) following routine care (13). They assessed the twoyear effect on disease activity and health-related quality of life and showed signi cantly higher odds (multivariable OR 1.89, 95% CI 1.33-2.68) for SDAI remission (≤ 3.3) in patients following a T2T strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Even though the T2T strategy has been widely applied in daily clinical practice nowadays, studies from daily clinical practice concerning the advantage of following T2T over usual care are still required. Several studies evaluating the e cacy of T2T in real clinical practice have been already done (4,(12)(13)(14)(15)(16)(17), but more evidence through real-life data is needed to support the implementation of T2T.…”

Section: Introductionmentioning

confidence: 99%

Switching First-Line Targeted Therapy After Not Reaching Low Disease Activity Within Six Months is Superior to Conservative Approach: A Propensity Score Matched Analysis From The ATTRA Registry

Nekvindová¹,

Vencovský²,

Pavelka³

et al. 2020

Preprint

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Background: Treat-to-target (T2T) is a widely accepted strategy for patients with rheumatoid arthritis (RA). It recommends attaining a goal of at least low disease activity (LDA) within six months; otherwise, the current therapy should be modified. We aimed to investigate whether switching a first-line targeted therapy (TT) in patients not reaching LDA within six months leads to a higher probability of meeting LDA at 12‑month visit in daily clinical practice using data from Czech registry ATTRA.Methods: We included patients with RA starting the first-line TT from 1 January 2012 to 31 January 2017 with at least one-year follow-up. We created four mutually exclusive cohorts based on 1) switching to another TT within the first year and 2) reaching a treatment target (DAS28-ESR ≤ 3.2) at the 6‑month visit. The primary outcome was the comparison of odds for reaching remission (REM) or LDA at the 12-month visit between patients switching and not switching TT after not reaching treatment target at six months. Before using logistic regression to estimate the odds ratio, we employed the propensity score to match patients at the 6-month visit.Results: A total of 1275 patients were eligible for the analysis. Sixty-two patients switched within the first five months of the treatment before evaluating treatment response at the 6-month visit (C1); 598 patients reached the treatment target within six months of therapy (C2); 124 patients did not reach treatment response at 6-month visit and switched to another therapy (C3), and 491 patients continued with the same treatment despite not reaching LDA at the 6‑month visit (C4). We matched 75 patients from cohort C3 and 75 patients from C4 using the propensity score. Patients following T2T principle (C3) showed 2.8 (95% CI 1.4–5.8; p=0.005) times increased likelihood of achieving REM/LDA at 12‑month visit compared to patients not following T2T strategy (C4).Conclusions: In daily clinical practice, the application of T2T strategy is underused. Switching TT after not reaching REM/LDA within the first six months leads to a higher probability of achieving REM/LDA in RA patients at the 12-month visit.

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Treat to target strategy in early rheumatoid arthritis versus routine care – A comparative clinical practice study

Cited by 34 publications

References 34 publications

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

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

Long-term clinical, functional, and cost outcomes for early rheumatoid arthritis patients who did or did not achieve early remission in a real-world treat-to-target strategy

Switching First-Line Targeted Therapy After Not Reaching Low Disease Activity Within Six Months is Superior to Conservative Approach: A Propensity Score Matched Analysis From The ATTRA Registry

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