Alexandre Sepriano1,2,3, Sofia Ramiro1,2,3, Oliver FitzGerald1,2,3, Mikkel Østergaard1,2,3, Joanne Homik1,2,3, Désirée van der Heijde1,2,3, Ori Elkayam1,2,3, J Carter Thorne1,2,3, Maggie J Larché1,2,3, Gianfranco Ferraccioli1,2,3, Marina Backhaus1,2,3, Gerd R Burmester1,2,3, Gilles Boire1,2,3, Bernard Combe1,2,3, Thierry Schaeverbeke1,2,3, Alain Saraux1,2,3, Maxime Dougados1,2,3, Maurizio Rossini1,2,3, Marcello Govoni1,2,3, Luigi Sinigaglia1,2,3, Alain Cantagrel1,2,3, Cheryl Barnabe1,2,3, Clifton O Bingham1,2,3, Paul P Tak1,2,3, Dirkjan van Schaardenburg1,2,3, Hilde Berner Hammer1,2,3, Joel Paschke1,2,3, Rana Dadashova1,2,3, Edna Hutchings1,2,3, Robert Landewé1,2,3, Walter P Maksymowych4,5,6. 1. From the Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Newman Clinical Research, Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; University of Alberta, Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Rheumatology Department, Centre Intégré Universitaire en Santé et Services Sociaux (CIUSSS) de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, Quebec; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; CaRE Arthritis Ltd., Edmonton, Alberta, Canada; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, Centre Hospitalier Universitaire (CHU) Montpellier, Montpellier; Service de rhumatologie, Centre National de Référence des Maladies Autoimmunes Rares de l'Adulte CERAINO, and UMR1227, Lymphocytes B et Autoimmunité (LBAI), Université de Brest, INSERM, LabEx Immunothérapies Grand Ouest (IGO), Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. 2. W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis, Ltd. 3. A. Sepriano, MD, PhD applicant, Department of Rheumatology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; O. FitzGerald, MD, Newman Clinical Research, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Professor, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Professor, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Professor, Service de rhumatologie, Centre National de Référence des Maladies Autoimmunes Rares de l'Adulte CERAINO, and UMR1227, LBAI, Université de Brest, INSERM, LabEx IGO; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital, Ferrara (loc. Cona); L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Professor, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Professor, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; R. Landewé, MD, Academic Medical Center/University of Amsterdam, and Zuyderland Medical Center; W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd. 4. From the Department of Rheumatology, Leiden University Medical Center, Leiden; Zuyderland Medical Center, Heerlen; Academic Medical Center/University of Amsterdam, Amsterdam University Medical Center, Amsterdam; Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center, Amsterdam, the Netherlands; Newman Clinical Research, Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark; University of Alberta, Edmonton, Alberta; The Arthritis Program Research Group, Newmarket, Ontario; Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario; Rheumatology Department, Centre Intégré Universitaire en Santé et Services Sociaux (CIUSSS) de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Sherbrooke, Quebec; Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta; CaRE Arthritis Ltd., Edmonton, Alberta, Canada; Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart, Rome; Department of Rheumatology, Università di Verona, Verona; St. Anna Hospital, Ferrara (loc. Cona); Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany; Departement de rhumatologie, Université de Montpellier, Centre Hospitalier Universitaire (CHU) Montpellier, Montpellier; Service de rhumatologie, Centre National de Référence des Maladies Autoimmunes Rares de l'Adulte CERAINO, and UMR1227, Lymphocytes B et Autoimmunité (LBAI), Université de Brest, INSERM, LabEx Immunothérapies Grand Ouest (IGO), Brest; Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris; Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse, Toulouse; Service de Rhumatologie, CHU Bordeaux Pellegrin, Bordeaux, France; Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. walter.maksymowych@carearthritis.com. 5. W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis, Ltd. walter.maksymowych@carearthritis.com. 6. A. Sepriano, MD, PhD applicant, Department of Rheumatology, Leiden University Medical Center; S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, and Zuyderland Medical Center; O. FitzGerald, MD, Newman Clinical Research, Department of Rheumatology, St. Vincent's University Hospital; M. Østergaard, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, University of Copenhagen; J. Homik, FRCP(C), Professor of Medicine, University of Alberta; D. van der Heijde, MD, Professor of Rheumatology, Department of Rheumatology, Leiden University Medical Center; O. Elkayam, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center; J.C. Thorne, FRCP(C), The Arthritis Program Research Group; M.J. Larché, MBChB, PhD, Divisions of Rheumatology and Clinical Immunology and Allergy, McMaster University; G. Ferraccioli, MD, Professor, Divisions of Rheumatology and Internal Medicine, Catholic University of the Sacred Heart; M. Backhaus, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G.R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; G. Boire, FRCP(C), Professor of Medicine, Rheumatology Department, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke; B. Combe, MD, PhD, Professor of Rheumatology, Departement de rhumatologie, Université de Montpellier, CHU Montpellier; T. Schaeverbeke, MD, Professor, Service de Rhumatologie, CHU Bordeaux Pellegrin; A. Saraux, MD, Professor, Service de rhumatologie, Centre National de Référence des Maladies Autoimmunes Rares de l'Adulte CERAINO, and UMR1227, LBAI, Université de Brest, INSERM, LabEx IGO; M. Dougados, MD, Professor of Medicine, Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité; M. Rossini, MD, Department of Rheumatology, Università di Verona; M. Govoni, MD, Associate Professor of Rheumatology, St. Anna Hospital, Ferrara (loc. Cona); L. Sinigaglia, MD, Department of Rheumatology, Istituto Ortopedico Gaetano Pini; A. Cantagrel, MD, Professor, Centre de Rhumatologie, Hôpital Pierre Paul Riquet - Purpan, CHU de Toulouse; C. Barnabe, MD, Associate Professor, Departments of Medicine and Community Health Services, Cumming School of Medicine, University of Calgary; C.O. Bingham III, MD, Professor, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; P.P. Tak, MD, Professor of Medicine, Academic Medical Center, Amsterdam University Medical Center; D. van Schaardenburg, MD, Professor of Medicine, Amsterdam Rheumatology and Immunology Center, locations Reade and Amsterdam, University Medical Center; H. Berner Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Paschke, BSc, CaRE Arthritis Ltd.; R. Dadashova, MD, CaRE Arthritis Ltd.; E. Hutchings, RN, CaRE Arthritis Ltd.; R. Landewé, MD, Academic Medical Center/University of Amsterdam, and Zuyderland Medical Center; W.P. Maksymowych, FRCP(C), Professor of Medicine, University of Alberta, and Chief Medical Officer, CaRE Arthritis Ltd. walter.maksymowych@carearthritis.com.
Abstract
OBJECTIVE: Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T. METHODS: Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model). RESULTS: A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02-1.19), smoking (OR 1.32, 95% CI 1.08-1.63) and high number of tender joints (OR 1.03, 95% CI 1.02-1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50-0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model. CONCLUSION: Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].
OBJECTIVE: Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T. METHODS: Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model). RESULTS: A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02-1.19), smoking (OR 1.32, 95% CI 1.08-1.63) and high number of tender joints (OR 1.03, 95% CI 1.02-1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50-0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model. CONCLUSION: Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].
Entities:
Keywords:
BEST TREATMENT PRACTICES; RHEUMATOID ARTHRITIS; TREAT-TO-TARGET
Authors: Bryant R England; Huifeng Yun; Lang Chen; Jared Vanderbleek; Kaleb Michaud; Ted R Mikuls; Jeffrey R Curtis Journal: Arthritis Care Res (Hoboken) Date: 2021-08-02 Impact factor: 5.178