RA Patients OK with Results Despite Missing Treatment Targets

Curtis JR, Shan Y, Harrold L, et al., Patient Perspectives on Achieving Treat-to-Target Goals: A Critical Examination of Patient-Reported Outcomes, Arthritis Care & Research; (2013) doi: 10.1002/acr.22048.  First published online September 24, 2013.

Rheumatoid arthritis (RA) patients who respond well to less than a year of biologic therapy report being content with their functioning even when they fall short of achieving low disease activity or remission by clinical measurement standards, according to an observational study. The upshot? The patient's perspective may sometimes trump guideline recommendations to strive aggressively for treatment targets, the authors say.

The study included more than 500 RA patients in the Consortium of Rheumatology Researchers of North America database who had a good clinical response to a new biologic therapy after three to six months, with improvements in the Clinical Disease Activity Index (CDAI) of  ≥10 units and Disease Activity Score (DAS) of >1.2 units.

In comparison with patients who stay in the same disease category, the 40% who drop to a lower disease-activity category reported significantly better outcomes for pain, fatigue, global assessment, and disability as measured by modified Health Assessment Questionnaire scores. The majority of those patients (86%) also hit the treatment target goals of low disease activity or remission without having to switch to a new biologic agent.

But even among patients who show improvements, less than half exceeded the minimum clinically important difference for patient-reported outcomes, the authors point out.

They note that some patients may be “satisfied enough” with reaching personal functioning goals and, as a result, may fear any changes to treatment in order to achieve low disease activity or remission. 

However, they also caution that for patients who have some meaningful clinical response, clinicians need to show restraint in pursuing treat-to-target goals. Overaggressive RA treatment “may not yield tangible improvements from patients’ perspectives,” they say.

The authors call for more research “to harmonize clinicians’ and patients’ RA treatment goals...and improve quality of care and achieve optimal RA outcomes for patients.”