I M Markusse1, L Dirven1, K H Han2, H K Ronday3, P B J de Sonnaville4, P J S M Kerstens5, W F Lems6, T W J Huizinga1, C F Allaart1. 1. Leiden University Medical Center, Leiden, The Netherlands. 2. Maasstad Hospital, Rotterdam, The Netherlands. 3. Haga Hospital, The Hague, The Netherlands. 4. Admiraal de Ruyter Hospital, Goes, The Netherlands. 5. Reade Hospital, Amsterdam, The Netherlands. 6. Reade Hospital and VU Medical Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions. METHODS: Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated. RESULTS:Protocol adherence decreased over time from 100% to 60% per visit, with an average over time of 79%. Rheumatologists mostly agreed with the DAS (80-90% of visits over time) and were satisfied with the treatment steps (75-90%) and with the level of RA suppression (85-90%). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95% CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95% CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95% CI 1.1-1.6). CONCLUSION: Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.
RCT Entities:
OBJECTIVE: To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions. METHODS: Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated. RESULTS: Protocol adherence decreased over time from 100% to 60% per visit, with an average over time of 79%. Rheumatologists mostly agreed with the DAS (80-90% of visits over time) and were satisfied with the treatment steps (75-90%) and with the level of RA suppression (85-90%). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95% CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95% CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95% CI 1.1-1.6). CONCLUSION: Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.
Authors: Yomei Shaw; Chung-Chou H Chang; Marc C Levesque; Julie M Donohue; Kaleb Michaud; Mark S Roberts Journal: Arthritis Care Res (Hoboken) Date: 2018-04-16 Impact factor: 4.794
Authors: Espen A Haavardsholm; Anna-Birgitte Aga; Inge Christoffer Olsen; Siri Lillegraven; Hilde B Hammer; Till Uhlig; Hallvard Fremstad; Tor Magne Madland; Åse Stavland Lexberg; Hilde Haukeland; Erik Rødevand; Christian Høili; Hilde Stray; Anne Noraas; Inger Johanne Widding Hansen; Gunnstein Bakland; Lena Bugge Nordberg; Désirée van der Heijde; Tore K Kvien Journal: BMJ Date: 2016-08-16
Authors: Emilia Gvozdenović; Ron Wolterbeek; Désirée van der Heijde; Tom Huizinga; Cornelia Allaart; Robert Landewé Journal: BMC Musculoskelet Disord Date: 2016-01-16 Impact factor: 2.362
Authors: G Akdemir; I M Markusse; Y P M Goekoop-Ruiterman; G M Steup-Beekman; B A M Grillet; P J S M Kerstens; W F Lems; T W J Huizinga; C F Allaart Journal: Clin Rheumatol Date: 2016-09-28 Impact factor: 2.980