Background Rheumatoid arthritis (RA) is a chronic, devastating disease with involvement of small and large joints. Treat-to-target strategy aims to improve the outcome of patients with RA and rapidly reduce disease activity by using properly and aggressively all the therapeutic options¹.

Objectives To estimate the efficacy of the first bDMARD, overall and by specific bDMARD, in RA patients, when administered according to international recommendations², compared to delayed initiation of bDMARDs (usual care) in an outpatient clinic.

Methods Disease activity was regularly measured by DAS-28 until the end of treatment with the first bDMARD. Good response to treatment was considered when remission or low disease activity was achieved. Cox proportional-hazards analyses and Kaplan-Meier (KM) plots were performed to assess the likelihood (hazard ratio, HR) of achieving a good response.

Results There were 113 patients in T2T and 250 patients in usual care group (study-sample characteristics, Table 1). Efficacy of treatment was measured at 3, 12, 24, 36 months and at the end of treatment (Table 2), with significant advantage of the T2T group (p<0.001). The IR for T2T group was 37.16 (95% CI 30.29–45.58) and for usual care group 17.26 (95% CI 14.54–20.50). The IRR between the 2 groups was 2.15.

The KM plots (Figure 1) depicted that the likelihood for a good response was significantly higher among patients of the T2T group (p<0.001), with comparable efficacy of the 3 classical bDMARDs: infliximab (p=0.008), adalimumab (p=0.018) and etanercept (p<0.001) (Figure 2). The HR of the likelihood of achieving good response was 1.71 (95% CI 1.18–2.47, p=0.004) in favor of the T2T group. Etanercept and the newer bDMARDs seemed to be more effective than infliximab or adalimumab whereas total steroid dose >500mg and swollen joint count (6–10) were found to be negative predictive factors for a good response.

Conclusions Treat-to-target treatment with bDMARDs offers a rapid and better long-term outcome to patients with RA, compared to delayed initiation of biologic treatment^3,4,5.

1. Grigor C, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 2004;364:263–9.

2. Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014;73:492–509.

3. van der Kooij SM, et al. Clinical and radiological efficacy of initial vs delayed treatment with infliximab plus methotrexate in patients with early rheumatoid arthritis. Ann Rheum Dis 2009;68:1153–8.

4. van der Bijl AE, et al. Infliximab and methotrexate as induction therapy in patients with early Rheumatoid Arthritis. Arthritis Rheum 2007;56:2129–34.

5. Keystone EC, et al. Clinical consequences of delayed addition of adalimumab to methotrexate therapy over 5 years in patients with Rheumatoid Arthritis. J Rheumatol 2011;38:855–62.

Disclosure of Interest None declared