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THU0067 Is Treat-To-Target Really Working? A Longitudinal Analysis in Biodam
  1. S. Ramiro1,
  2. R. Landewé2,
  3. D. van der Heijde1,
  4. O. FitzGerald3,
  5. M. Østergaard4,
  6. J. Homik5,
  7. O. Elkayam6,
  8. J.C. Thorne7,
  9. M. Larche8,
  10. G. Ferraccioli9,
  11. M. Backhaus10,
  12. G. Boire11,
  13. B. Combe12,
  14. T. Schaeverbeke13,
  15. A. Saraux14,
  16. M. Dougados15,
  17. S. Adami16,
  18. M. Govoni17,
  19. L. Sinigaglia18,
  20. A. Cantagrel19,
  21. C.F. Allaart1,
  22. C. Barnabe20,
  23. C.O. Bingham III21,
  24. P.P. Tak2,
  25. D. van Schaardenburg2,
  26. H.B. Hammer22,
  27. R. Dadashova23,
  28. E. Hutchings23,
  29. J. Paschke23,
  30. W.P. Maksymowych5,23
  1. 1LUMC, Leiden
  2. 2ARC, Amsterdam, Netherlands
  3. 3St Vincent's University Hospital, Dublin, Ireland
  4. 4Copenhagen UH at Glostrup, Copenhagen, Denmark
  5. 5University of Alberta, Edmonton, Canada
  6. 6Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  7. 7University of Toronto, Toronto
  8. 8McMaster University, Hamilton, Canada
  9. 9Catholic University of the Sacred Heart, Milan, Italy
  10. 10Charite UH, Berlin, Germany
  11. 11University of Sherbrooke, Quebec, Canada
  12. 12Lapeyronie Hospital and Montpellier University, Monpellier
  13. 13Pellegrin UH, Bordeaux
  14. 14CHU de la Cavale Blanche, Brest
  15. 15Paris Descartes University, Paris, France
  16. 16University of Verona, Verona
  17. 17University of Ferrara, Ferrara
  18. 18Gaetano Pini Institute, Milan, Italy
  19. 19CHU Toulouse, Toulouse, France
  20. 20University of Calgary, Calgary, Canada
  21. 21Johns Hopkinks University, Baltimore, United States
  22. 22Diakonhjemmet Hospital, Oslo, Norway
  23. 23CaRE Arthritis, Edmonton, Canada

Abstract

Background A Treat-to-Target approach (T2T), treating patients with RA towards a target, either remission or low disease activity (T2T-REM or T2T-LDA) is nowadays recommended. However it has never been assessed whether such a strategy in daily clinical practice really leads to more patients meeting that target.

Methods BIODAM is a 2-year prospective cohort including patients in daily practice with RA from 10 countries, who were started or changed on DMARD and/or anti-TNF treatment and were followed-up every 3 months. Participating physicians were required to practice T2T per protocol. Per visit was decided whether a patient was treated according to T2T or not. T2T-REM was considered met: i) if a patient had already a disease activity score below the target (DAS28-CRP<2.6); or ii) if treatment was intensified (by increasing dosage or adding drugs) upon a DAS28≥2.6. T2T-LDA was computed using the benchmark for low disease activity (LDA) (DAS28<3.2) (T2T-LDA). The main outcome was the presence or absence of ACR/EULAR-boolean remission 3 months after T2T-REM or T2T-LDA. Another outcome analysed was sustained remission (present >6 months). The relationship between T2T and ACR/EULAR Boolean remission 3 months later (or sustained remission) was investigated using generalized estimating equations with auto-regression.

Results In total 3084 visits of 539 patients (mean (SD) age: 56 (13) years, 76% female, disease duration 6 (8) years). In 68% of the visits, T2T-REM was applied (in 79% of the visits T2T-LDA was applied). ACR/EULAR-boolean remission was reached in 15% of the visits. Appropriate application of T2T-REM led to a 50% higher likelihood of ACR/EULAR-boolean remission 3 months later than not applying T2T-REM. Both T2T-REM and T2T-LDA strategies led to lower disease activity (with an exception of DAS28 remission or DAS28-LDA). Only 9% of the treatment intensifications followed upon a DAS28 between 2.6 and 3.2, and 79% of the intensifications were applied upon a DAS>3.2. Following T2T strategies led to higher achievement of sustained remission (table).

Conclusions A treat-to-target approach, even with a modest benchmark (DAS28 = 3.2), works and leads to a higher achievement of (sustained) ACR/EULAR-remission. Our study illustrates the importance of acting upon the data that is routinely collected in a clinical encounter. Rheumatologists should be encouraged to follow a treat-to-target approach in order to improve the outcome of their patients.

Disclosure of Interest None declared

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