Stricter treat-To-Target in RA does not result in less radiographic progression: A longitudinal analysis in RA BIODAM

Sofia Ramiro*, Robert Landewé, Désireé 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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 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 two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. Results: In total, 511 patients were included [mean (s.d.) 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 towards 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
Number of pages9
JournalRheumatology
Volume62
Issue number9
DOIs
StatePublished - 1 Sep 2023

Keywords

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

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