Treat-to-target in rheumatoid arthritis: a real-world study of the application and impact of treat-to-target within the wider context of patient management, patient centricity and advanced therapy use in Europe

Abstract

BackgroundWhile treat-to-target (T2T) is endorsed for the management of rheumatoid arthritis (RA), data on the degree of implementation in clinical practice are limited. This study investigated the use of T2T for RA in a real-world setting across Europe.MethodsThe Adelphi RA Disease-Specific Programme was a point-in-time survey of rheumatologists and their consulting patients with RA conducted between January and October 2020 in Belgium, France, Germany, Italy, Spain and the UK. Rheumatologists completed an attitudinal survey, and a record form for their next 10–12 consulting patients, who were invited to voluntarily complete a patient-reported questionnaire. Data collected included clinical characteristics, treatment patterns and attitudes towards T2T.ResultsOverall, 316 rheumatologists provided data for 3120 patients, of whom 1108 completed the questionnaire. While 86.1% of rheumatologists estimated using T2T principles in clinical practice, only 66.6% of patients were reported by their physician to be managed using a T2T approach. Achieving disease remission was the most commonly reported treatment goal identified by rheumatologists (79.7%), followed by symptom control (47.8%) and reducing impact on quality of life (44.5%). 40.8% of rheumatologists and their patients were in agreement that a treatment goal had been set. When there was agreement on treatment goals, we observed better patient satisfaction, engagement and treatment success.ConclusionsDespite recommendations, the T2T approach in RA appears to be suboptimally implemented in clinical practice. This highlights the importance of patient-centricity in the decision-making process to define meaningful targets and select appropriate treatments to improve disease outcomes.

Real‐World Treatment and Care Patterns in Patients With Rheumatoid Arthritis Initiating First‐Line Tumor Necrosis Factor Inhibitor Therapy in the United States

“…Both physicians and patients felt that use of these measures allowed them to better assess the impact of disease and take the steps necessary to improve disease status 21 . This is of great importance, as a study of European rheumatologists and their patients with RA demonstrated major discordance regarding established treatment goals 22 . Rheumatologists reported that they had implemented a treat‐to‐target approach in 90% of their patients, whereas only 57% of patients reported having a treatment goal or target set for their RA 22 .…”

“… 21 This is of great importance, as a study of European rheumatologists and their patients with RA demonstrated major discordance regarding established treatment goals. 22 Rheumatologists reported that they had implemented a treat‐to‐target approach in 90% of their patients, whereas only 57% of patients reported having a treatment goal or target set for their RA. 22 Similar findings were also demonstrated using a cross‐sectional survey of patients in the United States wherein 63% reported not discussing treatment goals with their providers.…”

“… 22 Rheumatologists reported that they had implemented a treat‐to‐target approach in 90% of their patients, whereas only 57% of patients reported having a treatment goal or target set for their RA. 22 Similar findings were also demonstrated using a cross‐sectional survey of patients in the United States wherein 63% reported not discussing treatment goals with their providers. 23 However, among those who did discuss treatment goals with their provider, 46.4% reported ≥70% improvement in disease activity, and 86% reported being satisfied with their current treatment plan.…”

Long-Term Safety, Efficacy, and Patient-Centered Outcomes of Filgotinib in the Treatment of Rheumatoid Arthritis: Current Perspectives

“…To supplement the existing PRO data, the Adelphi RA Disease Specific Programme has provided insight into the management of RA using patient-centric outcomes in real-world settings. 61 This large, multinational, point-in-time survey was conducted among rheumatologists and their patients with RA in Europe (Belgium, France, Germany, Italy, Spain, and UK) between January and October 2020. 61 Physicians completed record forms for clinical and treatment data including their rationales for current treatment choices.…”

“… 61 This large, multinational, point-in-time survey was conducted among rheumatologists and their patients with RA in Europe (Belgium, France, Germany, Italy, Spain, and UK) between January and October 2020. 61 Physicians completed record forms for clinical and treatment data including their rationales for current treatment choices. These were then categorized into clinical or patient-centric reasons.…”