Background Biological therapy is useful to prevent clinical and radiological progression in patients with rheumatoid arthritis (RA) when there is a failure with conventional DMARD therapy. Treat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA). On the other hand a multidisciplinary care team (MCT) model was generated in order to improve outcomes.
Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 24-month period in patients with biological DMARD therapy in a large cohort of patients from a Colombian specialized in RA center with a MCT model.
Methods A descriptive retrospective study was performed. Records of patients using biologics from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was according to DAS28: every 3–5 weeks (DAS28 >5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 <3.1). Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it. A MCT model means that a patient should be seen by other specialties such as physiatrist, physical and occupational therapy, nutritionist and psychologist at least 3 times a year. We divided patients in three groups: low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission (REM). Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level activity disease was analyzed using Pearson's statistics.
Results 370 patients were included in this study, 310 (83%) women and 60 (17%) men. Average age was 59 ± 9 years. The biological therapy was distributed: Infliximab 57 (15%), Abatacept 53 (14%), Adalimumab 53 (14%), Etanercept 52 (14%), Rituximab 46 (12%), Tocilizumab 46 (12%), Certolizumab 41 (11%), Golimumab 19 (5%). At 24 months was observed an increase in percentage of patients (up to 71%) in REM/LDA and a decrease in percentage of patients in MDA/SDA disease activity statistically significant. At beginning mean DAS28 was 4.3 ± 1.23 and after 24 months of follow-up mean DAS28 was 3.02 ± 0.72; the median was analyzed using t-Student assuming normality for DAS28 distribution; it showed improvement (p<0.00).
Conclusions There was a global improvement of DAS28 in a cohort of RA patients receiving biological therapy followed and treated under recommendations of T2T strategy and MCT model; this revision shows the importance of T2T follow-up and treatment for this disease.
Disclosure of Interest None declared