Background Heterogeneity in treatment strategies exist to varying degrees in the management of rheumatoid arthritis (RA). Assessment of impact of treat-to-target (T2T) approaches implemented in clinical practices may help identify best practices and to alleviate patient (pt) burden.
Objectives To assess the patterns of adoption of T2T approaches in RA and their impact on patient burden in Europe (EU5: UK/France/Germany/Italy/Spain).
Methods A multi-center medical chart-review study of RA pts was conducted among physicians (rheumatologists) in hospitals/private practices in EU5 to collect de-identified data on pts who were currently on (or recently discontinued ≤3mo) a biologic. Physicians were screened for practice-duration and patient-volume and recruited from a large panel to be geographically representative of respective countries. Patient charts of ∼5 successive pts visiting each center/practice during study period were selected. Physicians abstracted patient diagnosis, treatment patterns/dynamics and patient symptomatology/disease status (incl. assessment of “disease remission” per physician clinical judgment (both objective & subjective)). The adoption of the following T2T approaches was investigated: T2T-1: disease remission, with normalization of function; T2T-2: alleviate symptoms of disease or improve patient reported outcomes; T2T-3: Normalization of function or lower severity scores or inhibits disease progression; T2T-4: use validated composite measures of disease severity involving DAS28, tender joint count (TJC) or swollen JC (SJC) frequently; T2T-5: consider comorbidities (e.g., diabetes, obesity, heart disease), patient factors and drug-related risks; T2T-6: measure disease severity every month for moderate/severe disease pts and within 1–6 month frequency for mild/remission pts; T2T-7: Consider structural changes, functional impairment and comorbidity in addition to T2T-4; T2T-8: adjust drug therapy every 3mo until treatment target is reached; T2T-9: maintain desired treatment target for remaining course of disease; T2T-10: involve patient in treatment decisions. Pts for whom ≥7 T2T approaches applied (High-T2T) were compared to the rest (Low-T2T).
Results In 2Q2015, 1331 RA patient charts were abstracted across EU5; adoption of T2T approaches were:T2T-1:36%, T2T-2:38%, T2T-3:70%, T2T-4:87%, T2T-5:31%, T2T-6: 63%, T2T-7: 60%, T2T-8: 86%, T2T-9: 52%, T2T-10: 64%; High-T2T: 39% (range: 29% (Italy)-44% (UK/Spain)), Low-T2T: 61% (range: 56% (UK/Spain)- 71% (Italy)). Age, gender, time since RA diagnosis, duration of current/recent biologic and frequency of physician visits were similar between High-T2T & Low-T2T, whereas, time from diagnosis to first biologic initiation (40.7/46.6mo), % positive rheumatoid factor (89%/83%; p<.01), % positive anti-CCP (76% /71%; p<.05), mean TJC (3.5/4.3; p<.01), mean SJC (2.4/2.9; p<.05), school/work lost because of disease in last 3mo (3.0/4.6 days), % in remission (78%/47%; p<.01) differed between High-T2T/Low-T2T respectively.
Conclusions A significantly higher proportion of pts in High-T2T group were in remission and exhibited relatively lower disease burden. These observed patterns warrant further scrutiny to determine the best practices and profile pts still in need for improvement to alleviate burden.
Disclosure of Interest S. Narayanan Employee of: Ipsos Healthcare, Y. Lu Employee of: Ipsos Healthcare, R. Hutchings Employee of: Ipsos Healthcare, S. Mentzer Employee of: Ipsos Healthcare