TY - JOUR 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 DO - 10.3899/jrheum.190303 SP - jrheum.190303 AU - Alexandre Sepriano AU - Sofia Ramiro AU - Oliver FitzGerald AU - Mikkel Østergaard AU - Joanne Homik AU - Désirée van der Heijde AU - Ori Elkayam AU - Carter Thorne AU - Maggie J. Larché AU - Gianfranco Ferraccioli AU - Marina Backhaus AU - Gerd R. Burmester AU - Gilles Boire AU - Bernard Combe AU - Alain Saraux AU - Maxime Dougados AU - Maurizio Rossini AU - Marcello Govoni AU - Luigi Sinigaglia AU - Alain Cantagrel AU - Cheryl Barnabe AU - Clifton O. Bingham III AU - Paul P. Tak AU - Dirkjan van Schaardenburg AU - Hilde Berner Hammer AU - Joel Paschke AU - Rana Dadashova AU - Edna Hutchings AU - Robert Landewé AU - Walter P. Maksymowych Y1 - 2019/09/15 UR - http://www.jrheum.org/content/early/2019/09/11/jrheum.190303.abstract N2 - 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. ER -