Markusse I M, Dirven L, Han K H, Ronday H K, de Sonnaville P B J, Kerstens P J S M, Lems W F, Huizinga T W J, Allaart C F
Leiden University Medical Center, Leiden, The Netherlands.
Maasstad Hospital, Rotterdam, The Netherlands.
Arthritis Care Res (Hoboken). 2016 Apr;68(4):446-53. doi: 10.1002/acr.22681.
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.
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.
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).
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.
评估风湿病学家在类风湿关节炎（RA）患者治疗中对低疾病活动评分（DAS）引导的达标治疗（T2T）策略的依从性，并评估相关情况。
使用了BeSt研究的数据，这是一项为期10年随访的多中心T2T策略试验。在每3个月的访视期间，医生回答有关对RA抑制水平的满意度、对研究方案的认同度以及对DAS的认同度的问题。评估答案与不依从之间的关联。
方案依从性随时间从每次访视的100%降至60%，随时间的平均依从率为79%。风湿病学家大多认同DAS（随时间80 - 90%的访视），对治疗步骤（75 - 90%）和RA抑制水平（85 - 90%）感到满意。当风湿病学家不同意DAS时（当他们认为DAS高估实际疾病活动时，比值比[OR]为2.3，95%置信区间[95%CI]为2.0 - 2.7；当他们认为DAS低估实际疾病活动时，OR为2.5，95%CI为2.0 - 3.1），或不同意下一个所需治疗步骤时（OR为3.0，95%CI为2.5 - 3.5），以及当医生对疾病抑制不满意时（OR为1.3，95%CI为1.1 - 1.6），违反方案的几率更高。
风湿病学家总体上认同并遵循了一项为期10年随访的DAS引导的T2T策略。对DAS或所需治疗的不同意见以及对疾病抑制水平的不满意是不依从的危险因素。这些结果表明持续进行方案驱动的T2T治疗是可行的。对于日常实践，采用临床试验的结构组成部分可能会提高对T2T治疗的依从性。
