SAT0115 Trends in the activity of rheumatoid arthritis as the consequence of treat-to-target strategy: eight-year data from 2009 to 2016
Authors: W. Xie, J. Li, X. Zhang, G. Li, Y. Hao, J. Zhao, L. Wang, X. Sun, Y. Fan, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In 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. <h3>Objectives:</h3> To investigate the trends in the activity of RA over past 8 years and evaluate the value of T2T strategy in daily practice. <h3>Methods:</h3> 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. <h3>Results:</h3> 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&lt;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&lt;0.0001). Moreover, sub-cohort study revealed that more patients (49.3%&gt;73.2% vs. 19.1%&gt;34.5%, OR=2.4-3.0) achieved remission with a shorter median time compared with the non-T2T period group (p&lt;0.0001), particularly in DAS28-CRP (21 vs. &gt;52 weeks), DAS28-ESR (37 vs. &gt;52 weeks). <h3>Conclusions:</h3> Over past 8 years, the RA activity has substantially decreased and T2T strategy was directly attributable to the favorable changes in clinical practice. <h3>References:</h3> [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. <h3>Acknowledgements:</h3> We would like to thank all the patients, rheumatology nurses and rheumatologists who contributed to our study. <h3>Disclosure of Interest:</h3> None declared