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The impact of Treating to Target in patients with rheumatoid arthritis: Real world evidence from a single centre
Background
Treat to Target (T2T) recommendations are in place to inform rheumatologists and patients about evidence-based strategies for optimizing rheumatoid arthritis (RA) outcomes. This real world, prospective single centre audit evaluated the impact of T2T on RA management and patient outcomes.
Methods
Part of an ongoing UK-wide prospective audit of newly diagnosed patients with RA (patient recruitment: April 2012–December 2015), data collected by a single centre were extracted in August 2016. Patient data collected during routine rheumatology clinic visits, included demographics, disease management, treatments [including disease-modifying antirheumatic drugs (DMARDs)] prescribed, and outcomes. Where data were not available for all patients, the denominator is shown.
Results
The centre sample was n = 241, representing 15.2% of the audit sample (n = 1586). Mean (SD) time between first (baseline) and last visit: 9.4 (4.8) months; mean (SD) time between visits: 1.8 (1.4) months. Eighty-seven patients (36.1%) were male; median [interquartile range (IQR)] age at symptom onset: 61.1 years (50.0–69.5) (n = 192); median (IQR) time from symptom onset to baseline visit: 4.2 (2.8–8.1) weeks. RA diagnosis was made at baseline visit in 154/241 patients (63.9%), and within three subsequent months in 65/241 (27.0%). A target of remission [Disease Activity Score (DAS)28 <2.6] was set for 236/241 patients (97.9%) at baseline [mean (SD) baseline DAS28 score: 4.9 (1.3) (n = 230)]; target was achieved by 77/166 (46.4%) at six(±1.5) months, and by 54/79 patients (68.4%) at 12(±1.5) months. A DAS28 score was available for every visit in 146/241 patients (60.6%). DMARDs prescribed at baseline: monotherapy in 54/241 patients (22.4%) and dual therapy in 184/241 (76.3%); at 12(±1.5) months: monotherapy in 28/108 patients (25.9%), dual therapy in 74/108 (68.5% and triple therapy in 2/108 (1.9%). Mean (SD) time to dual and triple therapy: 0.4 (1.7) months (n = 203) and 8.2 (3.5) months (n = 6), respectively. Steroids prescribed at baseline: 123/241 patients (51.0%) intramuscular, 22/241 (9.1%) oral, and 11/241 (4.6%) intra-articular (not mutually exclusive); steroids at 12(±1.5) months: 72/108 patients (66.7%) intramuscular, 11/108 (10.2%) oral, and 1/108 (0.9%) intra-articular (not mutually exclusive).
Conclusions
First clinic visit and diagnosis occurred soon after RA symptom onset. In line with T2T recommendations, virtually all patients had a target set at baseline, although less than two-thirds had a DAS28 score available at every visit. Disease remission, a more ambitious clinical objective than low disease activity (LDAS, DAS28 2.6–3.2), was always used as the target set at baseline in these newly diagnosed patients. Where DAS28 scores were available at 12(±1.5) months, 68% patients had achieved their disease remission target. These data provide support for the Treat to Target approach. While most patients commenced combination therapy at baseline, few went on to receive triple therapy. The extent of steroid use demonstrates the ongoing clinical need for proactive and reactive management of RA symptoms
Authors
Ahmed Yousif, Martin Konar, Beena Salhan, Srinivasan Venkatachalam, Tom Sheeran
Journal
Rheumatology
Therapeutic Area
Rheumatology
Center of Excellence
Real-world Evidence & Data Analytics
Year
2017
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