AB0217 Validity of Treat To Target Strategy for Comprehensive Disease Control in Chinese Patients with Rheumatoid Arthritis: A Real-World, Prospective Cohort Study
Authors: J. Ma, X. Wang, Y. Mo, L. Chen, L. Dai
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> The ultimate goal for rheumatoid arthritis (RA) management is comprehensive disease control (CDC) including clinical remission, normal physical function and non-radiographic progression. However, current recommendations suggest that decision and adjustment of RA therapy mainly bases on disease activity and adheres to the treat-to-target (T2T) strategy which target is remission or low disease activity (LDA). Little was known about the validity of T2T strategy in achieving CDC in real world practice. <h3>Objectives</h3> To evaluate the validity and impact factors of T2T strategy in achieving CDC in Chinese RA patients. <h3>Methods</h3> Patients with moderately to severely active RA (DAS28-ESR≥3.2) were recruited and treated according to T2T strategy and followed up at the 1st, 3rd, 6th, and 12th months. Clinical data was collected simultaneously at baseline and each visit. X-ray assessment of hand/wrist was repeated and scored according to modified total Sharp score (mTSS). Therapeutic target was remission (DAS28-ESR&lt;2.6) or LDA (2.6≤DAS28-ESR&lt;3.2). One-year CDC was defined as DAS28-ESR&lt;2.6, HAQ score&lt;0.5 and mTSS≤0.5. <h3>Results</h3> (1) One hundred and three patients fulfilled 1-year follow-up. There were 33%, 48%, 57% and 56% patients achieved therapeutic target at the 1st, 3rd, 6th, 12th months respectively and 32% patients achieved CDC at the 12th month (Table 1). (2) Comparing with CDC-achieving group, the disease duration, baseline bony erosion and mTSS were significantly greater in CDC non-achieving group, while bDMARDs therapy was significantly less (all <i>P</i>&lt;0.05). Further multivariate logistic regression analysis showed that bDMARDs therapy was a significant predictor of CDC-achieving (OR: 3.089, 95% CI: 1.255–7.600, <i>P</i>=0.008), while bony erosion at baseline was a significant predictor of CDC-non-achieving (OR: 4.392, 95%CI: 1.484–12.998, <i>P</i>=0.008). (3) The percentages of patients achieved clinical remission and normal physical function in CDC-achieving group were significantly higher than those in CDC-non-achieving group at the 1st, 3rd, 6th, 12th months respectively (all <i>P</i>&lt;0.05). Univariate logistic regression analysis showed that remission and normal physical function at the 1st, 3rd, 6th were significant predictors of 1-year CDC (all <i>P</i>&lt;0.05). Adjusted for bony erosion at baseline and bDMARDs therapy, multivariate logistic regression analysis showed that remission at the 3rd month (OR: 4.159, 95% CI: 1.647–10.506, <i>P</i>=0.003) and normal physical function at the 1st month (OR: 8.199, 95% CI: 2.078–32.340, <i>P</i>=0.003) predicted 1-year CDC. <h3>Conclusions</h3> Our results implies only 32% patients achieved 1-year CDC under DAS28-based T2T strategy and the patients with baseline bony non-erosion, bDMARDs therapy and having rapid clinical and functional improvement within 3 months might be more likely to achieve 1-year CDC. <h3>Acknowledgement</h3> This work was supported by National Natural Science Foundation of China (81471597), Specialized Research Fund for the Doctoral Program of Higher Education (20130171110075) and Guangdong Natural Science Foundation (2014A030313074). <h3>Disclosure of Interest</h3> None declared