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 Sepriano, Alexandre
A1 Ramiro, Sofia
A1 FitzGerald, Oliver
A1 Østergaard, Mikkel
A1 Homik, Joanne
A1 van der Heijde, Désirée
A1 Elkayam, Ori
A1 Thorne, Carter
A1 Larché, Maggie J.
A1 Ferraccioli, Gianfranco
A1 Backhaus, Marina
A1 Burmester, Gerd R.
A1 Boire, Gilles
A1 Combe, Bernard
A1 Saraux, Alain
A1 Dougados, Maxime
A1 Rossini, Maurizio
A1 Govoni, Marcello
A1 Sinigaglia, Luigi
A1 Cantagrel, Alain
A1 Barnabe, Cheryl
A1 Bingham, Clifton O.
A1 Tak, Paul P.
A1 van Schaardenburg, Dirkjan
A1 Hammer, Hilde Berner
A1 Paschke, Joel
A1 Dadashova, Rana
A1 Hutchings, Edna
A1 Landewé, Robert
A1 Maksymowych, Walter P.
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.