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28-03-2022 | Rheumatoid arthritis | Adis Journal Club | Article

Rheumatology and Therapy

Towards a Better Implementation of Treat-to-Target Strategy in Rheumatoid Arthritis: A Comparison of Two Real-World Cohorts

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Authors: Hong Huang, Wenhui Xie, Yan Geng, Yong Fan, Yu Wang, Juan Zhao & Zhuoli Zhang

Abstract

Introduction

Treat-to-target (T2T) strategy has been the core of rheumatoid arthritis (RA) management for over a decade, although it implementation has varied distinctly in real practices. We report here our investigation of the differences in disease activity and target achievement of two patient cohorts with different T2T implementations.

Methods

Data of the CENTRA (Collaboratively intENsive Treat-to-target in RA) and TARRA (Treat-to-TARget in RA) cohorts were used. The CENTRA cohort is a RA cohort prospectively followed up by a fixed team with tight control, while the TARRA is a longitudinal observational cohort followed up by a rheumatologist with casual control. Patients from the two cohorts were matched 1:3 by propensity score matching. The primary outcome was the Simplified Disease Activity Index (SDAI) at the 1-year follow-up.

Results

Included in this analysis were 102 patients from the CENTRA cohort and 271 patients from the TARRA cohort. Both groups were comparable in terms of age, gender, disease course, and seropositivity. At the end of the 1-year follow-up, the SDAI of patients in the CENTRA cohort was significantly lower than that of patients in the TARRA cohort (2.1 vs. 3.4; p < 0.001). A similar result was obtained based on the generalized estimating equation (GEE) model (p = 0.009). In addition, more patients in the CENTRA cohort achieved SDAI-defined remission compared to the TARRA cohort [72 (70.6%) vs. 134 (49.4%); p < 0.001].

Conclusion

Patients with RA may benefit more from a tight control T2T strategy with closer follow-up and appropriate education compared with those with a casual T2T strategy.

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Key Summary Points

Why carry out this study?

The treat-to-target (T2T) strategy has substantially improved the prognosis of patients with rheumatoid arthritis (RA).

However, implementation of T2T strategies differs in real-world clinical practice, contributing to a significant proportion of patients with RA failing to achieve remission or low disease activity.

What was learned from this study?

Different implementations of T2T strategy have an influence on disease activity in patients with RA.

Patients with RA may benefit more from a tight control T2T strategy with closer follow-up and appropriate education compared with a casual T2T strategy.