SAT0104 INITIAL EVIDENCE FOR THE NEED OF A DUAL TREAT-TO-TARGET STRATEGY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Background 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. Objectives 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). Methods 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. Results 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. Conclusion 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.