AI Article Synopsis
- The study aimed to evaluate whether a "treat-to-target" approach could be more effective than usual care for patients with rheumatoid arthritis in the U.S.
- The trial involved cluster-randomizing rheumatology practices and included patients with moderate to high disease activity over a 12-month period.
- Results showed no significant differences between the treat-to-target group and the usual care group in terms of treatment acceleration or achieving low disease activity, highlighting challenges faced by healthcare providers in implementing this approach.
Article Abstract
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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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873265 | PMC |
| http://dx.doi.org/10.1002/acr.23294 | DOI Listing |
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