AB1414-HPR Long term effectiveness of a treat to target approach and impact in overall health in patients with rheumatoid arthritis – a 3 year follow-up
Authors: D Buitrago-Garcia, L. Villarreal, M. Cabrera, P. Santos-Moreno
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis (RA) is a common chronic inflammatory disease. It is characterised by progressive, irreversible joint damage, impaired joint function and pain, the disease causes disability and reduced quality of life. Treat-to-target (T2T) is an acknowledged management strategy for RA. It proposes that the therapeutic target in RA should be a state of remission, or an alternative goal could be a low disease activity, additionally it looks to achieve long-term health quality of life for the patient.<sup>1,2</sup> <h3>Objectives</h3> To describe the effectiveness of a T2T strategy regarding Disease Activity Score 28 (DAS28) in a 36 month period in patients who receive conventional or biological DMARDs and attend at least at four consults per year in a specialised in RA centre. <h3>Methods</h3> A descriptive cohort study was conducted. Medical records of patients from specialised in RA centre were reviewed between 2015–2017; those patients were followed-up under T2T standards and a multidisciplinary approach. Each patient had a minimum of 4 follow-up visits per year. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3–5 weeks (DAS28 &gt;5.1), every 7–9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11–13 weeks (DAS28 &lt;3.1). Therapy had to be adjusted with DAS28 &gt;3.2 unless patient's conditions don't permit it; We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients reached a LDA or REM. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We analysed normality for DAS28, in order to compare disease activity at beginning and the end of follow-up. <h3>Results</h3> During three years 1146 patients had confirmed RA and attended to a specialised centre with a minimum of 4 visits per year, 86% were female and 14% were men, mean DAS28 at baseline was 3.69±1.10 with a median of 3.1 while at 3 years mean DAS28 was 2.94±0.87 with a median of 2.79. At baseline 46% were in LDA, 40% in MDA and 13% were in SDA. Regarding pharmacological therapy 63% were receiving conventional DMARDs while 37% were receiving biological DMARDs. When we evaluated the effectiveness of T2T approach in terms of disease activity at the end of 36 months 42% achieved remission and 26% LDA (in total 68.5% of patients improved clinically) see table 1. We performed a Wilcoxon test in order to compare the mean DAS28 at baseline and at the end showing statistical significance (p&lt;0.05). <h3>Conclusions</h3> This real-world data demonstrates the effectiveness of a T2T multidisciplinary approach in patients with rheumatoid arthritis who remained in conventional or biological therapy during three years. <h3>References</h3> [1] Aletaha D, Alasti F, Smolen JS. Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Annals of the Rheumatic Diseases. 2015. [2] Cardiel MH. Treat to target strategy in rheumatoid arthritis: real benefits. Reumatologia clinica. 2013;9(2):101–5. <h3>Disclosure of Interest</h3> None declared