SAT0115 Trends in the activity of rheumatoid arthritis as the consequence of treat-to-target strategy: eight-year data from 2009 to 2016

Abstract

BackgroundIn past decades, treatment of rheumatoid arthritis (RA) has advanced greatly, driven largely by the advent of new medications and treat-to-target (T2T) strategy, but the secular trends in the activity and remission of RA over past years and the efficacy of T2T strategy are not fully validated in large population in real life practice.Objectives:To investigate the trends in the activity of RA over past 8 years and evaluate the value of T2T strategy in daily practice.Methods:All the medical records of RA patients from 2009 to 2016 were retrospectively reviewed. Disease activity scores at obtained visits were measured by DAS28-CRP, DAS28-ESR, SDAI and CDAI. To display trends over years, both mean and time-adjusted methods were applied in calculation of annual disease activity and remission rate. Disease activity and remission rate were also compared before and after the year of 2011 when application of T2T strategy was initiated in our center. Furthermore, a sub-cohort study including T2T and non-T2T period groups was conducted with outcome of cumulative percentage of remission and time to achieve first remission during the first year follow-up.Results:In total, 1,001 patients with 6,944 clinical visits were included. Over eight-year period, significant improvements were witnessed in disease activity and remission rate, measured by all four indices (p<0.0001). More patients achieved lower disease activity and higher remission rates after T2T adherence in 2011 compared to those in the years of 2009 and 2010 (P<0.0001). Moreover, sub-cohort study revealed that more patients (49.3%>73.2% vs. 19.1%>34.5%, OR=2.4-3.0) achieved remission with a shorter median time compared with the non-T2T period group (p<0.0001), particularly in DAS28-CRP (21 vs. >52 weeks), DAS28-ESR (37 vs. >52 weeks).Figure 1 Trends in disease activity scores over 8 years by four indices in mean and adjusted mean (AM) methods. (A) Trends based on DAS28-CRP and DAS28-ESR in two methods (B) Trends based on SDAI and CDAI in two methodsConclusions:Over past 8 years, the RA activity has substantially decreased and T2T strategy was directly attributable to the favorable changes in clinical practice.References:[1] Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010;376:1094-108.[2] Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized controlled trial. Lancet 2004;364(9430):263-9.[3] Verstappen SM, Jacobs JW, van der Veen MJ, Heurkens AH, Schenk Y, ter Borg EJ, et al. Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial). Ann Rheum Dis 2007;66(11):1443-9.[4] Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Kerstens PJ, et al. DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis. Ann Rheum Dis 2010;69(1):65-9.Acknowledgements:We wou...

Sustained clinical remission of rheumatoid arthritis and its predictive factors in an unselected adult Chinese population from 2009 to 2018

“…As demonstrated with solid evidence in our previous study, we have been complying with the T2T strategy since 2011 and defined patients as “with T2T therapy” when their first cohort entry was after 2011. Briefly, rheumatologists made the treatment decisions based on disease activity scores with musculoskeletal ultrasonic findings as reference for the explicit goal of achieving target.…”

“…Clinical remission or low disease activity has been an attainable goal for over half of patients with rheumatoid arthritis (RA) from previous studies, including one from our center . Sustained remission (SR), rather than remission at a single time point, is more desirable due to its association with better RA prognosis, reflected by quality of life, physical function, as well as radiographic progression …”

“…Clinical remission or low disease activity has been an attainable goal for over half of patients with rheumatoid arthritis (RA) from previous studies, including one from our center. [1][2][3][4] Sustained remission (SR), rather than remission at a single time point, is more desirable due to its association with better RA prognosis, 5,6 reflected by quality of life, physical function, as well as radiographic progression. [7][8][9] To date, there are several cohort studies reporting the rates of SR from 3% to 53%, mainly due to the different definitions of SR. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Although some of them further explored the relevant prognostic factors, [13][14][15][16]18,19,[21][22][23][24] obvious inconsistencies exist in the effect of gender, 13,16,19 serological antibodies, 13,16,24 baseline disease activity, 13,19,21 ...…”

Overlapping Sjogren’s syndrome reduces the probability of reaching target in rheumatoid arthritis patients: a propensity score matched real-world cohort from 2009 to 2019

“…Application of T2T concept is the key to successful RA management. The T2T concept has been generally adopted in our medical center since 2011, causing a dramatic decline in disease activity [20]. Therefore, we divided the treatment strategy into T2T and non-T2T according to the year of first visit prior to or after 2011, and "whether under the T2T concept" was used as an indicator variable to control the confounding effect caused by treatment differences.…”

Thu0081 elevated Serum Trem-1 Levels Are Associated With Das28 and Periodontitis in Rheumatoid Arthritis

“…The reasons varied. In our previous study, there was a substantially decrease of RA activity over 8 years after tight control applied [3]. However, whether T2T strategy can improve the long term radiographic outcomes in daily practice is still unknown.…”