Background The purpose of the T2T approach in RA is to achieve remission or LDA according to results from objective activity measurements. This strategy has proven clinical benefits, however objective adherence T2T measurement tools are lacked in daily practice.
Objectives To evaluate the setting, usage of a T2T adherence measure: T2T70 and T2T100, and its association with sustained low disease activity (LDAS) as a measure of outcome.
Methods Prospective study, consecutive patients with RA diagnosis (ACR/EULAR 2010) and follow-up between 1 and 24 months were included. Data from electronic medical record (EHR) were collected. Demographic variables, characteristics of the disease and treatment were recorded. The following T2T characteristics were defined and collected from each patient: number of visits, visits where treatment was adjusted, CDAI measurements, use of ultrasound to measure disease activity and achievement of LDA. Sustained LDA (LDAS) was defined when the patient had 2 or more records of that consecutive state of activity. Measures of adherence to T2T were defined as follows: T2T-70, when therapeutic decisions were accompanied by the measurement of activity by 70% and the interval between visits did not exceed 6 months; And T2T-100, when 100% of the decisions were accompanied with the activity measurement and the interval between each visit did not exceed 6 months. Statistical analysis: a descriptive analysis of the variables was performed and Chi2 test (categorical) and Student or MannWhitney test (continuous) were applied. For multivariate logistic regression analysis we considered as dependent variable LDAs.
Results 96 patients were included, with a mean follow-up of 15 months (DS 7.8), equivalent to 120.6 patients/year. Eighty percent of the patients were women, mean age 53.7 years (SD 13), disease duration 36 months (RIC, 12–52), 64% had early diagnosis, 85% and 75% positive For FR and ACPA, respectively. According to T2T characteristics, 526 visits were recorded, 270 were treatment adjustment and 208 (78%) of them were performed according to the CDAI value. The frequency of LDAS was 20% (IC95: 12–30). The frequency of T2T-70 compliance was 62.5% (IC95: 52–72) and T2T-100 was 42% (IC95: 32–52). Compliance with T2T-70 and T2T-100 presented a statistically significant association to the achievement of LDAS in the uni and multivariate analysis (p: 0.000). Compliance with T2T-70 and T2T-100 was associated with a shorter time course of disease; And T2T-70 also showed association with early diagnosis.
Conclusions T2T-70 and T2T-100 adherence were 62% and 42%, respectively, patients who met these criteria reached more LDAS. The early diagnosis and shorter time to disease evolution at baseline were variables that were variables that were associated with more compliance of these tools.
Acknowledgements Dra Josefina Marcos.
Disclosure of Interest None declared