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

Ramiro, S.; Landewé, R.; Heijde, D. van der; Sepriano, A.; FitzGerald, O.; Ostergaard, M.; Homik, J.; Elkayam, O.; Thorne, J.C.; Larché, M.J.; Ferraccioli, G.; Backhaus, M.; Boire, G.; Combe, B.; Schaeverbeke, T.; Saraux, A.; Dougados, M.; Rossini, M.; Govoni, M.; Sinigaglia, L.; Cantagrel, A.G.; Allaart, C.F.; Barnabe, C.; Bingham, C.O. .I.I.I.; Schaardenburg, D. van; Hammer, H.B.; Dadashova, R.; Hutchings, E.; Paschke, J.; Maksymowych, W.P.

doi:doi:10.1093/rheumatology/kead021

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...

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.

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