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  1. S. Ramiro1,2,
  2. R. B. M. Landewé2,3,
  3. D. Van der Heijde1,
  4. A. Sepriano4,
  5. O. Fitzgerald5,
  6. M. Østergaard6,
  7. J. Homik7,
  8. O. Elkayam8,
  9. C. Thorne9,
  10. M. Larché10,
  11. G. Ferraccioli11,
  12. M. Backhaus12,
  13. G. Boire13,
  14. B. Combe14,
  15. T. Schaeverbeke15,
  16. A. Saraux16,
  17. M. Dougados17,
  18. M. Rossini18,
  19. M. Govoni19,
  20. L. Sinigaglia20,
  21. A. Cantagrel21,
  22. C. Allaart1,
  23. C. Barnabe22,
  24. C. Bingham23,
  25. D. Van Schaardenburg3,
  26. H. B. Hammer24,
  27. R. Dadashova25,
  28. E. Hutchings25,
  29. J. Paschke25,
  30. W. P. Maksymowych7,25
  1. 1Leiden University Medical Center, Department of Rheumatology, Leiden, Netherlands
  2. 2Zuyderland Medical Center, Department of Rheumatology, Heerlen, Netherlands
  3. 3Amsterdam Rheumatology Center, Department of Rheumatology, Amsterdam, Netherlands
  4. 4Nova Medical School, Department of Rheumatology, Lisbon, Portugal
  5. 5Conway Institute for Biomolecular Research, School of Medicine, University College Dublin, Department of Rheumatology, Dublin, Ireland
  6. 6Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Department of Rheumatology, Copenhagen, Denmark
  7. 7University of Alberta, Department of Rheumatology, Alberta, Canada
  8. 8Tel Aviv Sourasky Medical Center and the ”Sackler” Faculty of Medicine, Tel Aviv University, Department of Rheumatology, Tel Aviv, Israel
  9. 9Southlake Regional Health Centre, University of Toronto, Department of Rheumatology, Toronto, Canada
  10. 10McMaster University, Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunology and Allergy, Hamilton, Canada
  11. 11Catholic University of the Sacred Heart, Department of Rheumatology, Rome, Italy
  12. 12Park-Klinik Weissensee, Academic Hospital of the Charité, Department of Rheumatology, Berlin, Germany
  13. 13Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke (CIUSSS de l’Estrie-CHUS), University of Sherbrooke, Department of Medicine/Division of Rheumatology, Sherbrooke, Canada
  14. 14CHU Montpellier and Montpellier University, Department of Rheumatology, Montpellier, France
  15. 15FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, Department of Rheumatology, Bordeaux, France
  16. 16LBAI, U1227, Université Brest, Inserm, CHU Brest, Department of Rheumatology, Brest, France
  17. 17Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Department of Rheumatology, Paris, France
  18. 18University of Verona, Rheumatology Unit, Department of Medicine, Verona, Italy
  19. 19S. Anna Hospital and University of Ferrara, Department of Rheumatology, Ferrara, Italy
  20. 20Gaetano Pini Institute, Department of Rheumatology, Milan, Italy
  21. 21CHU Toulouse, Paul Sabatier University. Toulouse, Department of Rheumatology, Toulouse, France
  22. 22University of Calgary, Departments of Medicine and Community Health Sciences, Alberta, Canada
  23. 23Johns Hopkins University, Department of Rheumatology, Baltimore, United States of America
  24. 24Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway
  25. 25CARE Arthritis LTD, Department of Rheumatology, Alberta, Canada


Background A Treat-to-Target approach (T2T) is broadly considered to lead to better clinical outcomes and recommended in patients with RA. However, very few studies have analyzed the effect of T2T on radiographic progression, and any such studies have provided inconsistent results.

Objectives To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice leads to lower radiographic progression in RA.

Methods Patients from the multicenter RA-BIODAM cohort with ≥2 consecutive visits with radiographs available were included. In RA-BIODAM patients were enrolled as they were initiating a new csDMARD/bDMARD treatment were followed-up with the intention to benchmark and intensify treatment. The primary outcome of this analysis was the change in Sharp-van der Heijde score (SvdH, 0-448), assessed every 6 months, using average scores from 2 readers (scores with known chronological order). Following a DAS44-T2T remission strategy, which was defined at each 3-month visit, was the main variable of interest. Patients were categorized based on the proportion of visits in which T2T was followed according to our definition: very low (≤40% of the visits, low (>40%, <62.5%), high (≥62.5%, ≤75%) and very high (>75%). Radiographic progression at 2 years was visualized across groups by cumulative probability plots. Per 3-month interval T2T could be followed zero, one or two times (in a total of 2 visits). Associations between the number of visits with T2T in an interval and radiographic progression, both in the same and in the subsequent 6-month interval, were analysed by generalised estimating equations, adjusted for age, gender, disease duration and country.

Results In total, 511 patients were included (mean (SD) age: 56 (13) years; 76% female). After 2 years, patients showed on average 2.2 (4.1) units progression (median:1 unit). Mean (SD) 2-year progression was not significantly different across categories of T2T: very low: 2.1 (2.7)-units; low: 2.8 (6.0); high: 2.4 (4.5), very high: 1.6 (2.2) (Figure 1). Meticulously following-up T2T in a 3-month interval neither reduced progression in the same 6-month interval (parameter estimates (for yes vs no): +0.15 units (95%CI: -0.04 to 0.33) for 2 vs 0 visits; and +0.08 units (-0.06;0.22) for 1 vs 0 visits) nor did it reduce progression in the subsequent 6-month interval (Table 1).

Table 1.

Effect of following DAS44-remission-T2T strategy on 6-month radiographic progression over 2 years

Figure 1.

Cumulative probability plot with 2-year radiographic progression according to the proportion of 3-monthly visits with T2T followed

Conclusion In this daily practice cohort, more meticulously following T2T principles did not result in more reduction of radiographic progression than a somewhat more liberal attitude toward T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.

Acknowledgements BIODAM was financially supported by an unrestricted grant from AbbVie

Disclosure of Interests Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Robert B.M. Landewé Speakers bureau: AbbVie, BMS, Gilead, Galapagos, GSK,Janssen, Lilly, Novartis, Pfizer, UCB, Consultant of: AbbVie, BMS, Gilead, Galapagos, GSK,Janssen, Lilly, Novartis, Pfizer, UCB

Dr Landewé owns Rheumatology Consultancy BV, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. Director of Imaging Rheumatology bv., Alexandre Sepriano Speakers bureau: Novartis, Consultant of: UCB, Oliver FitzGerald Speakers bureau: Biogen, Novartis, AbbVie, BMS, Pfizer, Grant/research support from: BMS, Novartis, UCB, Pfizer, Lilly, Janssen, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Orion, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, Amgen, BMS, Merck, Celgene and Novartis, Joanne Homik: None declared, Ori Elkayam Speakers bureau: Pfizer, Lilly, Novartis, Abbvie, BI, Janssen, Consultant of: Pfizer, Lilly, Novartis, Abbvie, BI, Janssen, Grant/research support from: Pfizer, Abbvie, Janssen, Carter Thorne Consultant of: Abbvie, Organon, Pfizer, Sandoz, Maggie Larché Speakers bureau: AbbVie, Actelion, Amgen, BMS, Boehringer-Ingelheim, Fresenius-Kabi, Gilead, Janssen, Mallinckrodt, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Sobi, UCB, Grant/research support from: Abbvie, BMS, Gianfranco Ferraccioli Speakers bureau: SOBI, Consultant of: Abbivie, Marina Backhaus: None declared, Gilles Boire Speakers bureau: Abbvie Canada, BMS Canada, Lilly Canada, Janssen Canada, Merck Canada, Pfizer Canada, Viatris, Consultant of: Abbvie Canada, Amgen Canada, BMS Canada, Celgene, GileadSciences, Janssen Canada, Lilly Canada, Merck Canada, Mylan Canada, Novartis Canada, Pfizer Canada, Roche Canada, Samsung Bioepis, Sanofi Canada, Teva, Grant/research support from: Lilly Canada, BMS Canada, Pfizer, Sandoz Canada, UCB Canada, Merck Canada, Novartis Canada, Roche Canada, Bernard Combe Speakers bureau: Abbvie, BMS,Celltrion,Galapgos-Gilead, Janssen, Lilly, MERCK, Pfizer,Roche-Chugai, Consultant of: Abbvie, Celltrion,Galapgos-Gilead, Janssen, Lilly, MERCK, Roche-Chugai, Grant/research support from: Pfizer, Roche-chugai, Thierry Schaeverbeke: None declared, Alain Saraux Speakers bureau: Abbvie, Lilly, Nordic, Novartis, Pfizer, Roche-Chugai, Sanofi, UCB, Consultant of: Abbvie, Lilly, Nordic, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Novartis, Fresenius, Lilly, Maxime Dougados Consultant of: Pfizer, AbbVie, UCB, Merck, Lilly, Novartis, BMS, Galapagos, Biogen, Roche, Grant/research support from: Pfizer, AbbVie, UCB, Merck, Lilly, Novartis, BMS, Galapagos, Biogen, Roche, Maurizio Rossini Speakers bureau: Amgen, Abbvie, BMS, Eli-Lilly, Galapagos,MSD, Novartis, Pfizer, Sandoz, Theramex, UCB, Marcello Govoni Speakers bureau: Abbvie, Pfizer, Galapagos, BMS, Eli-Lilly, Paid instructor for: Pfizer, Consultant of: Abbvie, BMS, Novartis, Astrazeneca, Pfizer, Luigi Sinigaglia: None declared, Alain Cantagrel Speakers bureau: Abbvie, Amgen, Biogen, BMS, Janssen, Lilly France, Médac, MSD France, Nordic-Pharma, Novartis, Pfizer, Sanofi Aventis, UCB, Consultant of: BMS, Janssen, Lilly France, MSD France, Sandoz, Grant/research support from: MSD France, Novartis, Pfizer, Cornelia Allaart: None declared, Cheryl Barnabe Speakers bureau: Sanofi Genzyme, Pfizer, Fresenius Kabi, Janssen, Consultant of: Gilead, Celltrion Healthcare, Clifton Bingham Consultant of: AbbVie, BMS, Eli Lilly, Janssen, Moderna, Pfizer, Sanofi, Grant/research support from: BMS, Dirkjan van Schaardenburg: None declared, Hilde Berner Hammer Speakers bureau: AbbVie, Novartis, Lilly, Rana Dadashova: None declared, Edna Hutchings: None declared, Joel Paschke: None declared, Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celgene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer

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