Higher RA Remission Rates Achieved With Treat-to-Target Strategy vs Routine Care

Radiograph of rheumatoid arthritis in the right hand
Radiograph of rheumatoid arthritis in the right hand
Higher remission rates and better quality of life were achieved in patients with rheumatoid arthritis who received a treat-to-target strategy.

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.

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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.

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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