OBJECTIVE:Treat-to-target (TTT) is an accepted paradigm for care of patients with rheumatoid arthritis (RA). Because TTT can be associated with more medication switches, concerns arise regarding whether implementing TTT may increase adverse events and/or resource use. The aim of this study was to examine adverse events and resource use during the preintervention and intervention periods of the TTT intervention trial. METHODS: We used data from 6 practices enrolled in an 18-month cluster-randomized controlled trial to compare adverse events and resource use before (months 1-9) and during (months 10-18) a TTT intervention. The outcomes of interest, adverse events and resource use, were based on medical record review of all rheumatology visits for RA patients before and during the intervention. RESULTS: We examined records for 321 patients before the intervention and 315 during the intervention. An adverse event was recorded in 10.2% of visits before the intervention and 8.8% of visits during the intervention (P = 0.41). Biologic disease-modifying antirheumatic drugs were taken by 53.6% of patients before the intervention and 49.8% of patients during the intervention (P = 0.73). Rheumatology visits were more frequent before the intervention (mean ± SD 4.0 ± 1.4) than during the intervention (mean ± SD 3.6 ± 1.2; P = 0.02). More visits were accompanied by monitoring laboratory tests before the intervention (90.0%) compared with during the intervention (52.7%; P < 0.001). A greater percentage of visits before the intervention included diagnostic imaging (15.4%) versus during the intervention (8.9%; P < 0.001). CONCLUSION: We observed similar rates of adverse events before and during the implementation of TTT for RA. Rheumatology visits, use of laboratory monitoring, and diagnostic imaging did not increase during the TTT intervention.
RCT Entities:
OBJECTIVE: Treat-to-target (TTT) is an accepted paradigm for care of patients with rheumatoid arthritis (RA). Because TTT can be associated with more medication switches, concerns arise regarding whether implementing TTT may increase adverse events and/or resource use. The aim of this study was to examine adverse events and resource use during the preintervention and intervention periods of the TTT intervention trial. METHODS: We used data from 6 practices enrolled in an 18-month cluster-randomized controlled trial to compare adverse events and resource use before (months 1-9) and during (months 10-18) a TTT intervention. The outcomes of interest, adverse events and resource use, were based on medical record review of all rheumatology visits for RApatients before and during the intervention. RESULTS: We examined records for 321 patients before the intervention and 315 during the intervention. An adverse event was recorded in 10.2% of visits before the intervention and 8.8% of visits during the intervention (P = 0.41). Biologic disease-modifying antirheumatic drugs were taken by 53.6% of patients before the intervention and 49.8% of patients during the intervention (P = 0.73). Rheumatology visits were more frequent before the intervention (mean ± SD 4.0 ± 1.4) than during the intervention (mean ± SD 3.6 ± 1.2; P = 0.02). More visits were accompanied by monitoring laboratory tests before the intervention (90.0%) compared with during the intervention (52.7%; P < 0.001). A greater percentage of visits before the intervention included diagnostic imaging (15.4%) versus during the intervention (8.9%; P < 0.001). CONCLUSION: We observed similar rates of adverse events before and during the implementation of TTT for RA. Rheumatology visits, use of laboratory monitoring, and diagnostic imaging did not increase during the TTT intervention.
Authors: Hertzel C Gerstein; Michael E Miller; Saul Genuth; Faramarz Ismail-Beigi; John B Buse; David C Goff; Jeffrey L Probstfield; William C Cushman; Henry N Ginsberg; J Thomas Bigger; Richard H Grimm; Robert P Byington; Yves D Rosenberg; William T Friedewald Journal: N Engl J Med Date: 2011-03-03 Impact factor: 91.245
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Authors: Josef S Smolen; Ferdinand C Breedveld; Gerd R Burmester; Vivian Bykerk; Maxime Dougados; Paul Emery; Tore K Kvien; M Victoria Navarro-Compán; Susan Oliver; Monika Schoels; Marieke Scholte-Voshaar; Tanja Stamm; Michaela Stoffer; Tsutomu Takeuchi; Daniel Aletaha; Jose Louis Andreu; Martin Aringer; Martin Bergman; Neil Betteridge; Hans Bijlsma; Harald Burkhardt; Mario Cardiel; Bernard Combe; Patrick Durez; Joao Eurico Fonseca; Alan Gibofsky; Juan J Gomez-Reino; Winfried Graninger; Pekka Hannonen; Boulos Haraoui; Marios Kouloumas; Robert Landewe; Emilio Martin-Mola; Peter Nash; Mikkel Ostergaard; Andrew Östör; Pam Richards; Tuulikki Sokka-Isler; Carter Thorne; Athanasios G Tzioufas; Ronald van Vollenhoven; Martinus de Wit; Desirée van der Heijde Journal: Ann Rheum Dis Date: 2015-05-12 Impact factor: 19.103
Authors: Xinfang Xie; Emily Atkins; Jicheng Lv; Alexander Bennett; Bruce Neal; Toshiharu Ninomiya; Mark Woodward; Stephen MacMahon; Fiona Turnbull; Graham S Hillis; John Chalmers; Jonathan Mant; Abdul Salam; Kazem Rahimi; Vlado Perkovic; Anthony Rodgers Journal: Lancet Date: 2015-11-07 Impact factor: 79.321
Authors: Daniel H Solomon; Theodore Pincus; Nancy A Shadick; Jacklyn Stratton; Jack Ellrodt; Leah Santacroce; Jeffrey N Katz; Josef S Smolen Journal: Arthritis Care Res (Hoboken) Date: 2022-02-04 Impact factor: 5.178