SAT0104 INITIAL EVIDENCE FOR THE NEED OF A DUAL TREAT-TO-TARGET STRATEGY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Claudia Oppenauer, Martina Durechova, Michael Zauner, Martin Posch, Susanne Urach, Klaus Machold, Daniel Aletaha, Ricardo Ferreira, Tanja Stamm
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The treat-to-target (T2T) strategy has been established as a key concept in the management of patients with rheumatoid arthritis (RA) aiming to achieve remission or at least low disease activity [1]. However, it might be more important for patients to set individual treatment goals which are related to their specific life context. For this reason, Ferreira at al [2] recently proposed a dual T2T strategy including both biological remission and individual patient reported symptom remission. It is currently unclear how achieving biological remission and individual patient treatment goals overlap and whether patients who reach the T2T target also reach their individual treatment goals. <h3>Objectives</h3> To explore if achieving T2T biological remission and individual patient treatment goals overlap in RA patients with initially low, moderate, or high disease activity (LDA, MDA, HDA). <h3>Methods</h3> We recruited a consecutive convenience sample of patients with RA diagnosed according to ACR/EULAR criteria and with LDA, MDA, or HDA into this observational longitudinal study. Disease activity was measured with the Clinical Disease Activity Index (CDAI) and the individual patient goals were assessed with the Goal Attainment Scale (GAS) at baseline and after three to five months. The number and proportion of patients who reach the T2T target, but not their individual goals and vice versa were calculated. <h3>Results</h3> We enrolled 162 patients in the study (131 [80.9%] women, median age 59.0, IQR= 49-71). 101 patients (62%) had a follow up visit with no missing data after three months. Of these, 48 (47.6%) patients had LDA, 43 (42.6%) had MDA, and 10 (9.9%) had HDA at baseline. 62 patients (61.4%) reached remission (14.7%) or stayed in LDA (46.1%), and 66 patients (65.3%) achieved their individual goal(s) (Table 1). 18 (17.8%) patients did not achieve their individual treatment goals, even if T2T was successful and 22 (21.8%) patients achieved their individual goals despite not reaching remission or LDA. <h3>Conclusion</h3> Our results indicate that most patients achieving T2T attain their individual treatment goals but a respectable part of T2T outcomes had to be supplemented by the individual patient reported treatment goals. <h3>References</h3> [1] Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis2017; 76(6): 960-977. [2] Ferreira RJO, Ndosi M, de Wit M, et al. Dual target strategy: a proposal to mitigate the risk of overtreatment and enhance patient satisfaction in rheumatoid arthritis. Ann Rheum Dis2018; [Epub ahead of print 22 Aug 2018]. <h3>Acknowledgement</h3> We want to thank all patients who participated in this study. Further thanks to the students Marie Louise Brand, Saskia Langthaller, Hanna Mües and Jim Schmeckenbecher for assisting in patient recruitment. <h3>Disclosure of Interests</h3> Claudia Oppenauer: None declared, Martina Durechova: None declared, Michael Zauner: None declared, Martin Posch: None declared, Susanne Urach: None declared, Klaus Machold Grant/research support from: Abbvie, Daniel Aletaha Grant/research support from: AbbVie, Bristol-Myers Squibb, and MSD, Consultant for: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Medac, Merck, MSD, Pfizer Inc, Roche, and UCB, Ricardo Ferreira: None declared, Tanja Stamm Grant/research support from: TS has received grant support from AbbVie., Paid instructor for: TS has received speaker fees from AbbVie, Janssen, MSD, Novartis, and Roche.