%0 Journal Article %A Alexandre Sepriano %A Sofia Ramiro %A Oliver FitzGerald %A Mikkel Østergaard %A Joanne Homik %A Désirée van der Heijde %A Ori Elkayam %A J. Carter Thorne %A Maggie J. Larché %A Gianfranco Ferraccioli %A Marina Backhaus %A Gerd R. Burmester %A Gilles Boire %A Bernard Combe %A Thierry Schaeverbeke %A Alain Saraux %A Maxime Dougados %A Maurizio Rossini %A Marcello Govoni %A Luigi Sinigaglia %A Alain Cantagrel %A Cheryl Barnabe %A Clifton O. Bingham III %A Paul P. Tak %A Dirkjan van Schaardenburg %A Hilde Berner Hammer %A Joel Paschke %A Rana Dadashova %A Edna Hutchings %A Robert Landewé %A Walter P. Maksymowych %T Adherence to Treat-to-target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort %D 2020 %R 10.3899/jrheum.190303 %J The Journal of Rheumatology %P 809-819 %V 47 %N 6 %X 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. Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling 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 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02–1.19), smoking (OR 1.32, 95% CI 1.08–1.63) and high number of tender joints (OR 1.03, 95% CI 1.02–1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 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. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956]. %U https://www.jrheum.org/content/jrheum/47/6/809.full.pdf