THU0082 EFFECT OF TREAT-TO-TARGET STRATEGY ON DISEASE ACTIVITY AND RADIOLOGIC OUTCOMES IN RHEUMATOID ARTHRITIS: RESULTS FROM A 9-YEAR CHINESE COHORT
Authors: Lanlan Ji, Wenhui Xie, LI Guangtao, Zhuoli Zhang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Treat-to-target (T2T) strategy has been implied in clinical practice for 9 years. However, a recent study showed that the radiologic outcome didn't associate with the adherence to protocolized treatment in clinical practice[1]. Furthermore, in clinical practice, nonadherence to a T2T protocol has been reported[2]. 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. Objectives: the arm of our study was to determine the effect of treat to target (T2T) protocol on disease activity and radiographic outcomes in a 9-year Chinese RA cohort. <h3>Methods</h3> RA patients who were followed-up for more than 1 year in a longitudinal observational cohort were included in our study. The adherence rate of the patients was evaluated by the calculation of the percentage of whether the patients followed the time schedule to clinic. Adherence rate≥0.7 was defined as adherent to T2T. The overall disease activity was evaluated by time adjusted mean (TAM) method. The radiological change was evaluated by radiographies of the hands regularly, with the interval between 1 and 3 years. We defined the primary radiological outcome as &amp;x25B3; modified total Sharp score (mTSS) &gt;3 over the follow-up time. <h3>Results</h3> There were 209 patients enrolled in our study. The median interval of two radiographies was 31.0 (17.0, 50.0) months. 45.0% of patients got clinical remission using TAM DAS28(ESR) and 25.4% of patients got the radiological outcome. Adherence rate was significantly negatively correlated with the mean disease activity [β coefficient=-0.423 (-0.540, -0.298), p=0.000, using DAS28ESR]. Moreover, adherent to T2T and baseline high disease activity (HDA) were independent predictors of radiological outcome [adherent to T2T: HR=0.47 (0.27, 0.82), p=0.007; baseline HDA: HR= 2.04 (1.16, 3.62), p=0.014] (Figure 1). As for bone erosion aspect, besides baseline HDA and adherent to T2T, baseline bone erosion existing also independently associated with erosion progression [HR=1.90 (1.12, 3.23), p=0.018]. When divided the adherence rate into three subgroups, we can find that patient not following the T2T protocol were more easily to get radiological progression. There was statistically significant difference among three groups (p=0.004 using log rank, and p=0.001 using Tarone ware). To our surprise, increased adherence rate didn't provide more benefit when adherence rate was more than 0.9 (Figure 2). In patients who got overall clinical remission, we found none of these variables correlated with the radiological outcome. <h3>Conclusion</h3> The mTSS progression was associated with baseline HDA and adherence rate, independently. Adherence to T2T strategy may improve the remission probability and halt the radiological deterioration, especially in the patients who didn't get clinical remission. <h3>References</h3> [1] Wabe NT, Sorich MJ, Wechalekar MD, et al. Effect of Adherence to Protocolized Targeted Intensifications of Disease-modifying Antirheumatic Drugs on Treatment Outcomes in Rheumatoid Arthritis: Results from an Australian Early Arthritis Cohort. J Rheumatol. 2016;43(9):1643–9. [2] Wabe N, Sorich MJ, Wechalekar MD, et al. Characterising deviation from treat-to-target strategies for early rheumatoid arthritis: the first three years. Arthritis Res Ther. 2015 Mar 8;17:48. [3] Xie W, Li J, Zhang X, et al. Trends in the activity of rheumatoid arthritis as the consequence of treat-to-target strategy: eight-year data from 2009 to 2016. Clin Exp Rheumatol. 2018 Sep-Oct;36(5):820-8. <h3>Acknowledgement</h3> None <h3>Disclosure of Interests</h3> None declared