Treat-to-Target Leads to Higher and Faster Remission in RA

The treat-to-target approach for rheumatoid arthritis patients is common in current treatment plans. But do more patients actually meet that target than those treated with another approach? A study presented by Sofia Ramiro, MD, at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., on Nov. 10, said they do.

The study used two-year data from BIODAM, a prospective cohort that included rheumatoid arthritis patients from 10 countries. These patients started on or were changed to disease-modifying anti-rheumatic drugs and/or anti-tumor necrosis factor therapy. They were followed every three months, and doctors were required to use treat-to-target protocol.

They found that the treat-to-target approach worked quickly and the patients had higher remission rates based on American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission rates. Researchers noted in the study that this approach is more effective for patients who hadn’t used disease-modifying anti-rheumatic drugs before, versus those who had.

“This is related to the window of opportunity that exists in the disease, and the earlier we start with treatment, the more successful we can be in suppressing the disease and inducing remission,” Dr. Ramiro, of Leiden University Medical Center, Netherlands, said in an interview with Rheumatology Network. “It is therefore not surprising that the same comes out of this analysis. It is again an argument in favor of the need for identifying and treating patients early.”

Ramiro noted that the likelihood that patients achieved remission based on the ACR/EULAR criteria was 50% higher if the treated-to-target was remission, versus not using a treat-to-target approach. They also had a 64% higher chance of sustained remission of at least six months duration, using the treat-to-target approach. These patients reached this remission target 3.7 times faster than patients not using this treatment strategy.

“Rheumatologists treating patients with rheumatoid arthritis should feel encouraged to follow a treat-to-target approach in order to improve the outcome of their patients,” Ramiro said. “We have shown that a treat-to-target (approach) works instantaneously and leads to higher remission rates, higher sustained remission rates and to a shorter time to remission.”

The treatment goal in principle should be remission, she said, especially in patients with early disease. In patients with established disease, though, remission might not be a reasonable target, since the window of opportunity is gone. In that case, the physician should aim for low disease activity.

References:

"Is Treat-to-Target Really Working? A Longitudinal Analysis in Biodam," Sofia Ramiro, MD. ACR 2015. Nov. 10, 2015.