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Is treat-to-target really working in rheumatoid arthritis? a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM).
Ramiro, Sofia; Landewé, Robert Bm; van der Heijde, Désirée; Sepriano, Alexandre; FitzGerald, Oliver; Ostergaard, Mikkel; Homik, Joanne; Elkayam, Ori; Thorne, J Carter; Larche, Margaret; Ferraccioli, Gianfranco; Backhaus, Marina; Boire, Gilles; Combe, Bernard; Schaeverbeke, Thierry; Saraux, Alain; Dougados, Maxime; Rossini, Maurizio; Govoni, Marcello; Sinigaglia, Luigi; Cantagrel, Alain G; Allaart, Cornelia F; Barnabe, Cheryl; Bingham, Clifton O; Tak, Paul P; van Schaardenburg, Dirkjan; Hammer, Hilde Berner; Dadashova, Rana; Hutchings, Edna; Paschke, Joel; Maksymowych, Walter P.
Afiliação
  • Ramiro S; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands sofiaramiro@gmail.com.
  • Landewé RB; Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.
  • van der Heijde D; Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.
  • Sepriano A; Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands.
  • FitzGerald O; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
  • Ostergaard M; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
  • Homik J; NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
  • Elkayam O; St Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.
  • Thorne JC; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • Larche M; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Ferraccioli G; Tel Aviv Sourasky Medical Center and the "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Backhaus M; Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada.
  • Boire G; Departments of Medicine and Pediatrics, Divisions of Rheumatology, Clinical Immunolgoy and Allergy, McMaster University, Hamilton, Ontario, Canada.
  • Combe B; Catholic University of the Sacred Heart, Roma, Italy.
  • Schaeverbeke T; Park-Klinik Weissensee, Academic Hospital of the Charité, Berlin, Germany.
  • Saraux A; Department of Medicine/Division of Rheumatology, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Universite de Sherbrooke, Sherbrooke, Quebec, Canada.
  • Dougados M; CHU Montpellier and Montpellier University, Montpellier, France.
  • Rossini M; Department of Rheumatology, FHU ACRONIM, University Hospital of Bordeaux, University of Bordeaux, Bordeaux, France.
  • Govoni M; Rheumatology, CHU Brest, Brest, France.
  • Sinigaglia L; Rheumatology Department, Paris Descartes University, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
  • Cantagrel AG; Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy.
  • Allaart CF; Rheumatology Unit, S. Anna Hospital and University of Ferrara, Ferrara, Italy.
  • Barnabe C; Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.
  • Bingham CO; Department of Rheumatology, Paul Sabatier University, Toulouse, France.
  • Tak PP; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
  • van Schaardenburg D; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
  • Hammer HB; Johns Hopkins University, Baltimore, Maryland, USA.
  • Dadashova R; Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands.
  • Hutchings E; Department of Rheumatology, Ghent University, Ghent, Belgium.
  • Paschke J; Department of Medicine, Cambridge University, Cambridge, United Kingdom.
  • Maksymowych WP; Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands.
Ann Rheum Dis ; 79(4): 453-459, 2020 04.
Article em En | MEDLINE | ID: mdl-32094157
OBJECTIVES: To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target. METHODS: RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models. RESULTS: In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52). CONCLUSION: In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Planejamento de Assistência ao Paciente / Artrite Reumatoide / Antirreumáticos / Inibidores do Fator de Necrose Tumoral Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Planejamento de Assistência ao Paciente / Artrite Reumatoide / Antirreumáticos / Inibidores do Fator de Necrose Tumoral Idioma: En Ano de publicação: 2020 Tipo de documento: Article