Is Treat-To-Target More Effective for Rheumatoid Arthritis?

Treating patients with rheumatoid arthritis towards a target of remission or low disease activity works immediately and leads to higher remission rates, according to research presented at the 2015 American College of Rheumatology in San Francisco.

“Treating towards remission is nowadays one of the main aims in the treatment of patients with RA,” explained lead study investigator Sofia Ramiro, MD, PhD from Leiden University Medical Center in Leiden, the Netherlands in a press release. “We have evidence that remission is the best outcome for patients, and therefore the treat-to-target strategy is recommended. However, until now, we didn’t have any study assessing the impact of following treat-to-target strategy on disease activity outcomes over time. BIODAM provided an optimal setting to test this, as patients from several countries are followed up over time, while rheumatologists are encouraged to follow a treat-to-target strategy.”

 

Researchers from the BIODAM report, an international study that aimed to validate biomarkers as predictors of joint damage and develop personalized treatment strategies for patients with rheumatoid arthritis, followed 539 patients (mean age 56 years, 76% female) who had a total of 3084 doctor visits in the course of 2 years. The patients had RA for an average of 6 years, and 49% had never taken a disease modifying antirheumatic drug (DMARD).

At the beginning of the study, patients were either started on or switched to a DMARD and/or anti-TNF. They had follow-up visits every 3 months during the study to see if they had successfully been treated to target. Those who did not reach a disease activity score below the target (DAS28-CRP≤2.6) had their treatment intensified either with increased dosage or adding new therapies. Treat-to-target for low disease activity was benchmarked at DAS28≤3.2.

A treat-to-target for remission was followed in 68% of visits, and a treat-to-target for low disease activity was followed in 79% of visits. The researchers found that the likelihood of achieving remission based on ACR/EULAR criteria was 52% higher when a treat-to-target strategy was followed compared with when a treat-to-target strategy was not followed. The researchers also found that treat-to-target for both remission and low disease activity led to lower disease activity, and that the effect of treat-to-target remission was stronger in those who had not previously taken DMARDs.

“A treat-to-target approach, even with a modest benchmark (low disease activity, or DAS28≤3.2), works immediately and leads to higher remission rates,” said Dr. Ramiro in a press release. “Treat to target is more effective in DMARD-naïve than in DMARD-experienced patients, and rheumatologists should be encouraged to follow a treat-to-target approach in order to improve the outcome of their patients.”

Reference

Ramiro S, Landewé RBM, van der Heijde D, et al. Abstract 3184. Is Treat-to-Target Really Working? a Longitudinal Analysis in Biodam. Presented at: 2015 ACR/ARHP Annual Meeting. Nov. 6-11, 2015; San Francisco, California.