Adherence to Treat-to-Target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort

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:

RA patients from 10 countries starting or changing conventional synthetic disease-modifying anti-rheumatic (csDMARDs) drugs and/or starting tumor necrosis factor inhibitor (TNFi) were followed for 2 years (RA BIODAM cohort). Participating physicians were required per-protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; DAS≤2.4) were analyzed in two types of binomial generalized estimating equations (GEE) models: i. including only baseline features (baseline model); ii. Modelling 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 (40.5%) visits. In the baseline multivariable model, high number of comorbidities (OR (95%CI): 1.10 (1.02; 1.19)), smoking (1.32 (1.08; 1.63)) and high number of tender joints (1.03 (1.02; 1.04)), were independently associated with failure to implement T2T, while ACPA/RF positivity (0.63 (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.

 2019 Sep 15. pii: jrheum.190303. doi: 10.3899/jrheum.190303. [Epub ahead of print]