Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM

Sofia Ramiro, Robert Landewé, Désirée van der Heijde, Alexandre Sepriano, Oliver FitzGerald, Mikkel Østergaard, Joanne Homik, Ori Elkayam, J Carter Thorne, Maggie J Larché, Gianfranco Ferraccioli, Marina Backhaus, Gilles Boire, Bernard Combe, Thierry Schaeverbeke, Alain Saraux, Maxime Dougados, Maurizio Rossini, Marcello Govoni, Luigi SinigagliaAlain G Cantagrel, Cornelia F Allaart, Cheryl Barnabe, Clifton O Bingham, Dirkjan van Schaardenburg, Hilde B Hammer, Rana Dadashova, Edna Hutchings, Joel Paschke, Walter P Maksymowych

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


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.

Original languageEnglish
Pages (from-to)2989 - 2997
Issue number9
Early online date16 Jan 2023
Publication statusPublished - 1 Sept 2023


  • outcomes
  • RA
  • radiographic progression
  • treat-To-Target


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