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. 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.
Original language | English |
---|---|
Pages (from-to) | 809-819 |
Number of pages | 11 |
Journal | Journal of rheumatology |
Volume | 47 |
Issue number | 6 |
Early online date | 15 Sept 2019 |
DOIs | |
Publication status | Published - 1 Jun 2020 |
Keywords
- Best treatment practices
- Rheumatoid arthritis
- Treat-to-target
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In: Journal of rheumatology, Vol. 47, No. 6, 01.06.2020, p. 809-819.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Adherence to treat-to-target management in rheumatoid arthritis and associated factors
T2 - Data from the International RA BIODAM Cohort
AU - Sepriano, Alexandre
AU - Ramiro, Sofia
AU - FitzGerald, Oliver
AU - Østergaard, Mikkel
AU - Homik, Joanne
AU - van der Heijde, D. sirée
AU - Elkayam, Ori
AU - Thorne, J. Carter
AU - Larché, Maggie J.
AU - Ferraccioli, Gianfranco
AU - Backhaus, Marina
AU - Burmester, Gerd R.
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
AU - Barnabe, Cheryl
AU - Bingham, Clifton O.
AU - Tak, Paul P.
AU - van Schaardenburg, Dirkjan
AU - Hammer, Hilde Berner
AU - Paschke, Joel
AU - Dadashova, Rana
AU - Hutchings, Edna
AU - Landewé, Robert
AU - Maksymowych, Walter P.
N1 - Funding Information: Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet – Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. This is an investigator-initiated study aimed at the clinical validation of biomarkers, which has been supported by unrestricted funding from AbbVie Corp. AbbVie had no role in the design, execution, or analysis of this study and had no role in the drafting of the manuscript. W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis, Ltd. A. Sepriano, MD, PhD applicant, Department of Rheumatology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; O. FitzGerald, MD, Newman Clinical Research, Department of Rheumatology, St. Vincent’s University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Professor, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l’Estrie–CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Professor, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Professor, Service de rhuma-tologie, Centre National de Référence des Maladies Auto-immunes Rares de l’Adulte CERAINO, and UMR1227, LBAI, Université de Brest, INSERM, LabEx IGO; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital, Ferrara (loc. Cona); L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Professor, Centre de Rhumatologie, Hôpital Pierre Paul Riquet – Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Professor, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; R. Landewé, MD, Academic Medical Center/University of Amsterdam, and Zuyderland Medical Center; W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd. Address correspondence to Dr. W.P. Maksymowych, CaRE Arthritis, #210, 316 Windemere Road NW, Edmonton, Alberta T6W 2Z8, Canada. E-mail: walter.maksymowych@carearthritis.com Accepted for publication August 22, 2019. Publisher Copyright: Copyright © 2020. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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.
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. 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.
KW - Best treatment practices
KW - Rheumatoid arthritis
KW - Treat-to-target
UR - http://www.scopus.com/inward/record.url?scp=85085903940&partnerID=8YFLogxK
U2 - https://doi.org/10.3899/jrheum.190303
DO - https://doi.org/10.3899/jrheum.190303
M3 - Article
C2 - 31523049
SN - 0315-162X
VL - 47
SP - 809
EP - 819
JO - Journal of rheumatology
JF - Journal of rheumatology
IS - 6
ER -