Abstract
BackgroundLittle is known on how well targeted treatment, for instance targeting towards low DAS, is implemented in clinical practice. Our aim was to evaluate treatment adjustments in response to DAS in RA patients in clinical practice.MethodsWe used data from one referral centre, multiple rheumatologists, from the METEOR database. Generalized Estimating Equations (GEE) were used to assess whether in case of non-low disease activity (DAS > 2.4) treatment intensifications in DMARD therapy occurred ((change or increase in dose or number of DMARDs, including synthetic (s)DMARDs, biologic (b)DMARDs and corticosteroids compared to the visit before)). Determinants of not intensifying the treatment when DAS > 2.4 were investigated using GEE.ResultsFive thousand one hundred fifty-seven registered visits of 1202 patients were available for the analyses. A DAS > 2.4 was weakly (OR: 1.19; 95 % CI 1.07–1.33) associated with a treatment intensification. In 69 % (n = 3577) of the visits patients were in low disease activity. In 66 % (n = 1028) of the visits with DAS > 2.4 treatment was not intensified. These patients had a higher tender joint count and received more often methotrexate plus a bDMARD, or csDMARD monotherapy, as compared to patients that received treatment intensification.ConclusionIn the majority of visits in the METEOR database patients were already in a state of low disease activity, reflecting appropriate treatment intensity. When DAS was greater than 2.4, treatment was often not intensified due to high tender joint count or specific treatment combinations. This data suggest that while aiming for low DAS, physicians per patient weigh whether all DAS elements indicate disease activity or will respond to DMARD adjustment or not, and make treatment decisions accordingly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0878-1) contains supplementary material, which is available to authorized users.
Highlights
Little is known on how well targeted treatment, for instance targeting towards low Disease Activity Score (DAS), is implemented in clinical practice
In total 5157 registered visits in 1202 patients who were treated with Synthetic disease-modifying anti rheumatic drug (sDMARDs) and/or Biologic disease-modifying anti rheumatic drug (bDMARDs) and/ or corticosteroids, were available for the analyses
After a high DAS was followed with no change or increase in medication, at the following visit a good or moderate improvement in DAS was observed in 47 (17 %) of the recorded 283 visits. In this analysis from daily practice observations collected in the METEOR database, we obtained information about how the treat to target recommendation in rheumatoid arthritis (RA) is followed in a single large academic referral centre (LUMC)
Summary
Little is known on how well targeted treatment, for instance targeting towards low DAS, is implemented in clinical practice. Our aim was to evaluate treatment adjustments in response to DAS in RA patients in clinical practice. The aim of treatment in rheumatoid arthritis (RA) is to achieve low disease activity or remission using a ‘treat to target’ (tight control) approach in which the disease activity of patients is monitored intensively and measured frequently with composite measures [1,2,3]. Since treatment to target and tight control have been proven to result in better clinical and radiological outcomes than routine care, [5,6,7,8,9,10,11] these concepts are at the basis of the current recommendations for the management of rheumatoid arthritis in daily practice. It is well known that limited adherence to guidelines is prevalent in many chronic conditions, such as atrial fibrillation, hypertension and osteoporosis [19,20,21]
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