In patients with rheumatoid arthritis (RA), higher rates of remission and improved health-related quality of life were achieved with a treat-to-target strategy in clinical practice compared with the use of traditional routine care, according to the results of a cohort study published in Seminars in Arthritis and Rheumatism.
The Norwegian Very Early Arthritis Cohort 2.0, a multicenter prospective observational study included individuals 18 to 75 years between 2010 and 2015. Participants were treated with a treat-to-target strategy, which included visits at baseline, at 3, 6, 9, and 12 months, and then every 6 months plus monthly visits until 28-joint count Disease Activity Score <2.6 was achieved. Data from patients in the treat-to-target cohort were compared with data from a pre-treat-to-target cohort of patients older than 18 years from the Norwegian Disease Modifying Anti-Rheumatic Drug (NOR-DMARD) register between 2006 and 2009. Both groups had a clinical diagnosis of RA for ≤1 year and were naive to DMARDs.
The primary study outcome was Simple Disease Activity Index (SDAI) remission (≤3.3) at the 2-year follow-up. Secondary outcomes included the proportion of patients in SDAI remission after 3 and 6 months and at 1 year, as well as mean changes in health-related quality of life based on EuroQoL-5 Dimensions (EQ-5D) during follow-up.
A total of 293 patients were included in the treat-to-target cohort. Mean participant age was 54.4 ± 13.1 years and 65.5% of the patients were women. The routine care cohort included 392 patients with a mean age of 53.8 ± 13.3 years and 67.9% of these participants were women.
At 2 years, the proportion of patients achieving SDAI remission was 46% in the treat-to-target cohort vs 31% in the routine care cohort. Median EQ-5D score was similar at baseline but differed significantly between the treat-to-target (0.77; 95% CI, 0.69-0.85) and routine care cohorts (0.73; 95% CI, 0.59-0.80) at 2 years (P <.001). In both cohorts, methotrexate monotherapy was the primary DMARD used to attain SDAI remission.
The investigators concluded that in individuals with RA, implementation of treat-to-target follow-up in clinical practice is both feasible and beneficial to patients.
Brinkmann GH, Norvang V, Norli ES, et al. Treat to target strategy in early rheumatoid arthritis versus routine care – A comparative clinical practice study [published online July 25, 2018]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2018.07.004