Stricter treat-to-target in RA does not result in less radiographic progression: a longitudinal analysis in RA BIODAM

• Published in: Rheumatology (Oxford, England) England), 2023-09, Vol.62 (9), p.2989-2997
• Main Authors: Ramiro, Sofia, Landewé, Robert, van der Heijde, Désirée, Sepriano, Alexandre, FitzGerald, Oliver, Østergaard, Mikkel, Homik, Joanne, Elkayam, Ori, Thorne, J Carter, Larché, Maggie J, Ferraccioli, Gianfranco, Backhaus, Marina, Boire, Gilles, Combe, Bernard, Schaeverbeke, Thierry, Saraux, Alain, Dougados, Maxime, Rossini, Maurizio, Govoni, Marcello, Sinigaglia, Luigi, Cantagrel, Alain G, Allaart, Cornelia F, Barnabe, Cheryl, Bingham, Clifton O, van Schaardenburg, Dirkjan, Hammer, Hilde B, Dadashova, Rana, Hutchings, Edna, Paschke, Joel, Maksymowych, Walter P
• Format: Article
• Language: English
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kead021

Abstract Objectives To investigate whether meticulously following a treat-to-target (T2T)-strategy in daily clinical practice will lead to less radiographic progression in patients with active RA who start (new) DMARD-therapy. Methods Patients with RA from 10 countries starting/changing conventional synthetic or biologic DMARDs because of active RA, and in whom treatment intensification according to the T2T principle was pursued, were assessed for disease activity every 3 months for 2 years (RA-BIODAM cohort). The primary outcome was the change in Sharp-van der Heijde (SvdH) score, assessed every 6 months. Per 3-month interval DAS44-T2T could be followed zero, one or two times (in a total of two visits). The relation between T2T intensity and change in SvdH-score was modelled by generalized estimating equations. Results In total, 511 patients were included [mean (s.d.) age: 56 (13) years; 76% female]. Mean 2-year SvdH progression was 2.2 (4.1) units (median: 1 unit). A stricter application of T2T in a 3-month interval did not reduce progression in the same 6-month interval [parameter estimates (for yes vs no): +0.15 units (95% CI: −0.04, 0.33) for 2 vs 0 visits; and +0.08 units (−0.06; 0.22) for 1 vs 0 visits] nor did it reduce progression in the subsequent 6-month interval. Conclusions In this daily practice cohort, following T2T principles more meticulously did not result in less radiographic progression than a somewhat more lenient attitude towards T2T. One possible interpretation of these results is that the intention to apply T2T already suffices and that a more stringent approach does not further improve outcome.