Journal Article

Long-term outcomes of treat-to-target strategy in established rheumatoid arthritis: a daily practice prospective cohort study

Viecceli, Daniela, de Andrade, Nicole Pamplona Bueno, de Oliveira Filho, Cilomar Martins, Xavier, Ricardo Machado, Brenol, Claiton Viegas, Correa, Ricardo Henrique Bilycz, da Silva Chakr, Rafael Mendonça

2017

Overview

To examine disease activity and physical function after implementation of treat-to-target (T2T) strategy in patients with established rheumatoid arthritis (RA) over a long-term period. Patients with RA were started on a T2T strategy in 2005 and followed through 2014. Patients were seen every 3–4 months until remission/low disease activity was achieved and every 6 months thereafter. Disease activity was measured by the DAS28 and CDAI, and physical function by the HAQ-DI. Results were presented as all observed data, without imputation for missing values. Changes in disease activity and physical function were evaluated by generalized estimating equations (GEE). Two hundred and twenty-nine patients were included, with a mean (SD) disease duration of 10.6 (7.4) years. Significant improvements were seen in both composite scores during the follow-up period, as demonstrated by DAS28 ( β coefficient = 0.19; 95% CI = 0.16–0.21; p  < 0.01) and by CDAI ( β coefficient = 1.59; 95% CI = 1.84–1.34; p  < 0.01). Physical function also improved, as demonstrated by HAQ-DI ( β coefficient = 0.03; 95% CI = 0.02–0.04; p  < 0.01). Biological therapy was associated with improvement in disease activity and in physical function. Leflunomide was only associated with improvement in physical function. Clinically meaningful reductions of DAS28, CDAI and HAQ-DI were observed in patients with established rheumatoid arthritis from 2005 to 2014. Implementation of new therapeutic options, in the scenario of T2T strategy, was associated with improvement in disease activity and physical function.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adult / Aged / Antirheumatic Agents - therapeutic use / Arthritis, Rheumatoid - diagnosis / Arthritis, Rheumatoid - drug therapy / Arthritis, Rheumatoid - immunology / Arthritis, Rheumatoid - physiopathology / Biological Products - therapeutic use / Cohort analysis / Disability Evaluation / Female / Health risk assessment / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Observational Research / Prospective Studies / Recovery of Function / Remission Induction / Rheumatoid arthritis / Rheumatology / Severity of Illness Index / Time Factors / Treatment Outcome / Tumor Necrosis Factor-alpha - antagonists & inhibitors / Tumor Necrosis Factor-alpha - immunology