Department of Orthopedics and Physical Rehabilitation; Department of Medicine, Division of Preventive And Behavioral Medicine
Behavioral Medicine | Behavior and Behavior Mechanisms | Immune System Diseases | Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases
OBJECTIVE: To assess the feasibility and efficacy of implementing a treat-to-target approach versus usual care in a US-based cohort of rheumatoid arthritis patients.
METHODS: In this behavioral intervention trial, rheumatology practices were cluster-randomized to provide treat-to-target care or usual care. Eligible patients with moderate/high disease activity (Clinical Disease Activity Index [CDAI] score > 10) were followed for 12 months. Both treat-to-target and usual care patients were seen every 3 months. Treat-to-target providers were to have monthly visits with treatment acceleration at a minimum of every 3 months in patients with CDAI score > 10; additional visits and treatment acceleration were at the discretion of usual care providers and patients. Coprimary end points were feasibility, assessed by rate of treatment acceleration conditional on CDAI score > 10, and achievement of low disease activity (LDA; CDAI score < /=10) by an intent-to-treat analysis.
RESULTS: A total of 14 practice sites per study arm were included (246 patients receiving treat-to-target and 286 receiving usual care). The groups had similar baseline demographic and clinical characteristics. Rates of treatment acceleration (treat-to-target 47% versus usual care 50%; odds ratio [OR] 0.92 [95% confidence interval (95% CI) 0.64, 1.34]) and achievement of LDA (treat-to-target 57% versus usual care 55%; OR 1.05 [95% CI 0.60, 1.84]) were similar between groups. Treat-to-target providers reported patient reluctance and medication lag time as common barriers to treatment acceleration.
CONCLUSION: This study is the first to examine the feasibility and efficacy of a treat-to-target approach in typical US rheumatology practice. Treat-to-target care was not associated with increased likelihood of treatment acceleration or achievement of LDA, and barriers to treatment acceleration were identified.
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© 2017, The Authors. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
DOI of Published Version
Arthritis Care Res (Hoboken). 2018 Mar;70(3):379-387. doi: 10.1002/acr.23294. Epub 2018 Feb 6. Link to article on publisher's site
Arthritis care and research
Harrold LR, Reed GW, John A, Barr CJ, Soe K, Magner RP, Saunders KC, Ruderman EM, Haselkorn T, Greenberg JD, Gibofsky A, Harrington JT, Kremer JM. (2018). Cluster-Randomized Trial of a Behavioral Intervention to Incorporate a Treat-to-Target Approach to Care of US Patients With Rheumatoid Arthritis. Open Access Publications by UMass Chan Authors. https://doi.org/10.1002/acr.23294. Retrieved from https://escholarship.umassmed.edu/oapubs/3385
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
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