Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohortReport as inadecuate




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Arthritis Research and Therapy

, 14:R254

First Online: 23 November 2012Received: 08 August 2012Revised: 09 November 2012Accepted: 20 November 2012

Abstract

IntroductionClinical trials have demonstrated that treatment-to-target T2T is effective in achieving remission in early rheumatoid arthritis RA. However, the concept of T2T has not been fully implemented yet and the question is whether a T2T strategy is feasible in daily clinical practice. The objective of the study was to evaluate the adherence to a T2T strategy aiming at remission Disease Activity Score in 28 joints DAS28 < 2.6 in early RA in daily practice. The recommendations regarding T2T included regular assessment of the DAS28 and advice regarding DAS28-driven treatment adjustments.

MethodsA medical chart review was performed among a random sample of 100 RA patients of the DREAM remission induction cohort. At all scheduled visits, it was determined whether the clinical decisions were compliant to the T2T recommendations.

ResultsThe 100 patients contributed to a total of 1,115 visits. The DAS28 was available in 97.9% 1,092-1,115 of the visits, of which the DAS28 was assessed at a frequency of at least every three months in 88.3% 964-1,092. Adherence to the treatment advice was observed in 69.3% 757-1,092 of the visits. In case of non-adherence when remission was present 19.5%, 108-553, most frequently medication was tapered off or discontinued when it should have been continued 7.2%, 40-553 or treatment was continued when it should have been tapered off or discontinued 6.2%, 34-553. In case of non-adherence when remission was absent 42.1%, 227-539, most frequently medication was not intensified when an intensification step should have been taken 34.9%, 188-539. The main reason for non-adherence was discordance between disease activity status according to the rheumatologist and DAS28.

ConclusionsThe recommendations regarding T2T were successfully implemented and high adherence was observed. This demonstrates that a T2T strategy is feasible in RA in daily clinical practice.

AbbreviationsACRAmerican College of Rheumatology

Anti-CCPanti-cyclic citrullinated peptide

Anti-TNFanti-tumor necrosis factor

CRPC-reactive protein

DAS28Disease Activity Score in 28 joints

DMARDsdisease-modifying antirheumatic drugs

DREAMDutch Rheumatoid Arthritis Monitoring

ESRerythrocyte sedimentation rate

EULAREuropean League Against Rheumatism

HAQHealth Assessment Questionnaire

IQRinterquartile range

MCSmental component summary

MTXmethotrexate

PCSphysical component summary

PGApatient global assessment

RArheumatoid arthritis

RCTsrandomized controlled trials

RFrheumatoid factor

SDstandard deviation

SF-36Short-Form 36 health survey

SJC28swollen joint count in 28 joints

SSZsulfasalazine

T2Ttreat-to-target

TJC28tender joint count in 28 joints

TNFtumor necrosis factor

VASvisual analogue scale.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4099 contains supplementary material, which is available to authorized users.

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Author: Marloes Vermeer - Hillechiena H Kuper - Hein J Bernelot Moens - Monique Hoekstra - Marcel D Posthumus - Piet LCM van Rie

Source: https://link.springer.com/







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