Patient perspectives on achieving treat-to-target goals: a critical examination of patient-reported outcomes
Authors
Curtis, Jeffrey R.Shan, Ying
Harrold, Leslie R.
Zhang, Jie
Greenberg, Jeffrey D.
Reed, George W.
UMass Chan Affiliations
Department of Medicine, Division of Preventive and Behavioral MedicineDepartment of Orthopedics and Physical Rehabilitation
Document Type
Journal ArticlePublication Date
2013-10-01Keywords
AdultAged
Antirheumatic Agents
Arthritis, Rheumatoid
Biological Products
Disability Evaluation
Disease Progression
Female
*Health Knowledge, Attitudes, Practice
Humans
Least-Squares Analysis
Male
Middle Aged
Multivariate Analysis
Pain Measurement
Patients
*Perception
Predictive Value of Tests
Remission Induction
*Self Report
Severity of Illness Index
Time Factors
Treatment Outcome
Musculoskeletal Diseases
Rheumatology
Metadata
Show full item recordAbstract
OBJECTIVE: Treat-to-target (T2T) recommendations suggest that rheumatoid arthritis (RA) patients should strive for remission or low disease activity (LDA). However, it is unclear whether patients experiencing a good response to biologic agents might experience further improvement in patient-reported outcomes (PROs) if they subsequently achieve a lower disease activity state, particularly the T2T goals of LDA or remission. METHODS: Using the Consortium of Rheumatology Researchers of North America database, we identified RA patients initiating biologic agents. We restricted the analysis to patients with improvement (Clinical Disease Activity Index [CDAI] improvement of >/=10 units) at 3-6 months (baseline visit; n = 1,368) with a followup visit approximately 9 months later (n = 984). Patients in CDAI remission or with a worsened disease activity category were excluded, leaving 562 eligible patients. PROs (global assessment, pain, and fatigue by 0-10 visual analog scales and disability by the modified Health Assessment Questionnaire [M-HAQ]) were examined at these 2 visits. Mean change in PROs compared achievement of a lower disease activity category versus staying in the same disease activity category, adjusting for potential confounders. RESULTS: Patients who achieved a lower disease activity category (40% of the eligible cohort, 86% of these achieving LDA or remission) had significantly better improvement in patient pain (-14.9; 95% confidence interval [95% CI] -18.4, -11.6), patient global (-17.5; 95% CI -20.8, -14.3), fatigue (-8.5; 95% CI -15.8, -1.3), and M-HAQ score (-0.13; 95% CI -0.18, -0.08) compared to patients who stayed in the same disease activity category. However, even for patients improving, fewer than half exceeded the minimum clinically important difference for each PRO. CONCLUSION: Achievement of a lower disease activity disease state, especially T2T goals, was associated with further improvement in PROs, albeit modest in magnitude.Source
Curtis, J. R., Shan, Y., Harrold, L., Zhang, J., Greenberg, J. D. and Reed, G. W. (2013), Patient Perspectives on Achieving Treat-to-Target Goals: A Critical Examination of Patient-Reported Outcomes. Arthritis Care Res, 65: 1707–1712. doi: 10.1002/acr.22048. Link to article on publisher's site
DOI
10.1002/acr.22048Permanent Link to this Item
http://hdl.handle.net/20.500.14038/42961PubMed ID
23740824Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1002/acr.22048