TY - JOUR
T1 - Stricter treat-to-target in RA does not result in less radiographic progression
T2 - a longitudinal analysis in RA BIODAM
AU - Ramiro, Sofia
AU - Landewé, Robert
AU - van der Heijde, Désirée
AU - Sepriano, Alexandre
AU - FitzGerald, Oliver
AU - Østergaard, Mikkel
AU - Homik, Joanne
AU - Elkayam, Ori
AU - Thorne, J Carter
AU - Larché, Maggie J
AU - Ferraccioli, Gianfranco
AU - Backhaus, Marina
AU - Boire, Gilles
AU - Combe, Bernard
AU - Schaeverbeke, Thierry
AU - Saraux, Alain
AU - Dougados, Maxime
AU - Rossini, Maurizio
AU - Govoni, Marcello
AU - Sinigaglia, Luigi
AU - Cantagrel, Alain G
AU - Allaart, Cornelia F
AU - Barnabe, Cheryl
AU - Bingham, Clifton O
AU - van Schaardenburg, Dirkjan
AU - Hammer, Hilde B
AU - Dadashova, Rana
AU - Hutchings, Edna
AU - Paschke, Joel
AU - Maksymowych, Walter P
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].
PY - 2023/9/1
Y1 - 2023/9/1
N2 - OBJECTIVES: To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active rheumatoid arthritis (RA) who start (new) DMARD-therapy.METHODS: Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of 2 visits). The relation between T2T intensity and change in SvdH-score was modelled by generalised estimating equations.RESULTS: In total, 511 patients were included (mean (SD) age: 56 (13) years; 76% female). Mean 2-year SvdH progression was 2.2 (4.1) units (median : 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval (parameter estimates (for yes vs no): +0.15 units (95%CI: -0.04-0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits) nor did it reduce progression in the subsequent 6-month interval.CONCLUSIONS: In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude toward T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
AB - OBJECTIVES: To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active rheumatoid arthritis (RA) who start (new) DMARD-therapy.METHODS: Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of 2 visits). The relation between T2T intensity and change in SvdH-score was modelled by generalised estimating equations.RESULTS: In total, 511 patients were included (mean (SD) age: 56 (13) years; 76% female). Mean 2-year SvdH progression was 2.2 (4.1) units (median : 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval (parameter estimates (for yes vs no): +0.15 units (95%CI: -0.04-0.33) for 2 vs 0 visits; and +0.08 units (-0.06; 0.22) for 1 vs 0 visits) nor did it reduce progression in the subsequent 6-month interval.CONCLUSIONS: In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude toward T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.
KW - outcomes
KW - RA
KW - radiographic progression
KW - treat-To-Target
U2 - 10.1093/rheumatology/kead021
DO - 10.1093/rheumatology/kead021
M3 - Article
C2 - 36645243
SN - 1462-0332
VL - 62
SP - 2989
EP - 2997
JO - Rheumatology
JF - Rheumatology
IS - 9
ER -