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.
W.P. Maksymowych is Chief Medical Officer of the International Project Management Group, CaRE Arthritis, Ltd.
J Rheumatol. 2020 Jun 1;47(6):809-819. doi: 10.3899/jrheum.190303. Epub 2019 Sep 15.
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.
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).
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.
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].
有充分证据支持针对目标（T2T）的治疗策略可改善类风湿关节炎（RA）的结局。关于妨碍实施 T2T 的因素知之甚少，尤其是在严格遵循 T2T 方案的情况下。我们旨在评估与未能遵循 T2T 相关的临床因素。
来自 10 个国家的开始或改变传统合成改善病情抗风湿药和/或开始使用肿瘤坏死因子抑制剂的 RA 患者接受了 2 年的随访。根据方案要求，参与医生必须遵循 T2T 策略。分析了 2 种二项式广义估计方程模型中影响 T2T 低疾病活动度（T2T-LDA；28 个关节疾病活动度评分≤2.4）的因素：（1）仅包括基线特征（基线模型）；（2）建模随时间变化的变量（纵向模型）。
共纳入 571 例患者，其中 439 例（76.9%）完成了 2 年随访。在 1765 次就诊中，有 1765 次（40.5%）未能达到 T2T-LDA。在基线多变量模型中，共病数量多（比值比 1.10，95%置信区间 1.02-1.19）、吸烟（比值比 1.32，95%置信区间 1.08-1.63）和较多的压痛关节（比值比 1.03，95%置信区间 1.02-1.04）与未能实施 T2T 独立相关，而抗瓜氨酸蛋白抗体/类风湿因子阳性（比值比 0.63，95%置信区间 0.50-0.80）是 T2T 的显著促进因素。纵向模型中的结果相似。
尽管这是方案要求，但在 RA BIODAM 队列中仍有相当一部分患者未能遵循 T2T，这可以通过临床特征预测。[类风湿关节炎（RA）BIODAM 队列；临床试验注册：NCT01476956]。
