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Research ArticleAccepted Article

Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort

Alexandre Sepriano, Sofia Ramiro, Oliver FitzGerald, Mikkel Østergaard, Joanne Homik, Désirée van der Heijde, Ori Elkayam, Carter Thorne, Maggie J. Larché, Gianfranco Ferraccioli, Marina Backhaus, Gerd R. Burmester, Gilles Boire, Bernard Combe, Alain Saraux, Maxime Dougados, Maurizio Rossini, Marcello Govoni, Luigi Sinigaglia, Alain Cantagrel, Cheryl Barnabe, Clifton O. Bingham III, Paul P. Tak, Dirkjan van Schaardenburg, Hilde Berner Hammer, Joel Paschke, Rana Dadashova, Edna Hutchings, Robert Landewé and Walter P. Maksymowych
The Journal of Rheumatology September 2019, jrheum.190303; DOI: https://doi.org/10.3899/jrheum.190303
Alexandre Sepriano
From the Department of Rheumatology, Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands; Newman Clinical Research, Department of Rheumatology, St. Vincent’s University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark; University of Alberta; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; The Arthritis Program Research Group, Newmarket, Canada; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Canada; Divisions of Rheumatology and Internal Medicine Catholic University of the Sacred Heart, Rome, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Rheumatology Department, CIUSSS de l’Estrie-CHUS, Université de Sherbrooke, Sherbrooke, Canada; Departement de rhumatologie, Univ Montpellier, CHU Montpellier, Montpellier, France; Centre National de Référence des Maladies Auto-immunes Rares de l'Adulte CERAINO, and UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest, France; Paris Descartes University, Rheumatology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, FRANCE; Department of Rheumatology, Università di Verona, Verona, Italy; St Anna Hospital, Ferrara (loc. Cona), Italy; Centre de Rhumatologie, Hôpital Pierre Paul Riquet – Purpan. CHU de Toulouse, Toulouse, France; Departments of Medicine and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Canada; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, USA; Academic Medical Center, Amsterdam University Medical Center,Amsterdam, The Netherlands; Amsterdam Rheumatology and immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; CARE Arthritis. Address correspondence to Walter P. Maksymowych, CARE Arthritis, #210, 316 Windemere Road NW, Edmonton, Alberta, Canada T6W 2Z8. Email: walter.maksymowych@carearthritis.com
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Sofia Ramiro
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Oliver FitzGerald
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Mikkel Østergaard
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Joanne Homik
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Désirée van der Heijde
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Ori Elkayam
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Carter Thorne
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Maggie J. Larché
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Gianfranco Ferraccioli
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Marina Backhaus
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Gerd R. Burmester
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Gilles Boire
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Bernard Combe
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Alain Saraux
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Maxime Dougados
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Maurizio Rossini
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Marcello Govoni
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Luigi Sinigaglia
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Alain Cantagrel
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Cheryl Barnabe
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Clifton O. Bingham III
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Paul P. Tak
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Dirkjan van Schaardenburg
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Hilde Berner Hammer
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Joel Paschke
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Rana Dadashova
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Edna Hutchings
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Robert Landewé
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Walter P. Maksymowych
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Abstract

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.

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The Journal of Rheumatology
Vol. 52, Issue 6
1 Jun 2025
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Accepted manuscript
Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort
Alexandre Sepriano, Sofia Ramiro, Oliver FitzGerald, Mikkel Østergaard, Joanne Homik, Désirée van der Heijde, Ori Elkayam, Carter Thorne, Maggie J. Larché, Gianfranco Ferraccioli, Marina Backhaus, Gerd R. Burmester, Gilles Boire, Bernard Combe, Alain Saraux, Maxime Dougados, Maurizio Rossini, Marcello Govoni, Luigi Sinigaglia, Alain Cantagrel, Cheryl Barnabe, Clifton O. Bingham, Paul P. Tak, Dirkjan van Schaardenburg, Hilde Berner Hammer, Joel Paschke, Rana Dadashova, Edna Hutchings, Robert Landewé, Walter P. Maksymowych
The Journal of Rheumatology Sep 2019, jrheum.190303; DOI: 10.3899/jrheum.190303

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Accepted manuscript
Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort
Alexandre Sepriano, Sofia Ramiro, Oliver FitzGerald, Mikkel Østergaard, Joanne Homik, Désirée van der Heijde, Ori Elkayam, Carter Thorne, Maggie J. Larché, Gianfranco Ferraccioli, Marina Backhaus, Gerd R. Burmester, Gilles Boire, Bernard Combe, Alain Saraux, Maxime Dougados, Maurizio Rossini, Marcello Govoni, Luigi Sinigaglia, Alain Cantagrel, Cheryl Barnabe, Clifton O. Bingham, Paul P. Tak, Dirkjan van Schaardenburg, Hilde Berner Hammer, Joel Paschke, Rana Dadashova, Edna Hutchings, Robert Landewé, Walter P. Maksymowych
The Journal of Rheumatology Sep 2019, jrheum.190303; DOI: 10.3899/jrheum.190303
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