RT Journal Article SR Electronic T1 Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.190303 DO 10.3899/jrheum.190303 A1 Alexandre Sepriano A1 Sofia Ramiro A1 Oliver FitzGerald A1 Mikkel Østergaard A1 Joanne Homik A1 Désirée van der Heijde A1 Ori Elkayam A1 Carter Thorne A1 Maggie J. Larché A1 Gianfranco Ferraccioli A1 Marina Backhaus A1 Gerd R. Burmester A1 Gilles Boire A1 Bernard Combe A1 Alain Saraux A1 Maxime Dougados A1 Maurizio Rossini A1 Marcello Govoni A1 Luigi Sinigaglia A1 Alain Cantagrel A1 Cheryl Barnabe A1 Clifton O. Bingham III A1 Paul P. Tak A1 Dirkjan van Schaardenburg A1 Hilde Berner Hammer A1 Joel Paschke A1 Rana Dadashova A1 Edna Hutchings A1 Robert Landewé A1 Walter P. Maksymowych YR 2019 UL http://www.jrheum.org/content/early/2019/09/11/jrheum.190303.abstract AB Objective Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol specified. We aimed to assess clinical factors that associate with failure to adhere to T2T. Methods RA patients from 10 countries starting or changing conventional synthetic disease-modifying anti-rheumatic (csDMARDs) drugs and/or starting tumor necrosis factor inhibitor (TNFi) were followed for 2 years (RA BIODAM cohort). Participating physicians were required per-protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; DAS≤2.4) were analyzed in two types of binomial generalized estimating equations (GEE) models: i. including only baseline features (baseline model); ii. Modelling variables that inherently vary over time as such (longitudinal model). Results A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 (40.5%) visits. In the baseline multivariable model, high number of comorbidities (OR (95%CI): 1.10 (1.02; 1.19)), smoking (1.32 (1.08; 1.63)) and high number of tender joints (1.03 (1.02; 1.04)), were independently associated with failure to implement T2T, while ACPA/RF positivity (0.63 (0.50; 0.80)), was a significant facilitator of T2T. Results were similar in the longitudinal model. Conclusion Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement and this could be predicted by clinical features.