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Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study.
Arthritis Rheum. 2011 Oct; 63(10):2865-72.AR

Abstract

OBJECTIVE

Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a treat-to-target strategy aimed at achieving remission in very early RA in daily clinical practice.

METHODS

Five hundred thirty-four patients with a clinical diagnosis of very early RA were included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Treatment adjustments were based on the Disease Activity Score in 28 joints (DAS28), aiming at a DAS28 of <2.6 (methotrexate, followed by the addition of sulfasalazine, and exchange of sulfasalazine with biologic agents in case of persistent disease activity). The primary outcome was disease activity after 6 months and 12 months of followup, according to the DAS28, the European League Against Rheumatism (EULAR) response criteria, and the modified American College of Rheumatology (ACR) remission criteria. Secondary outcomes were time to first DAS28 remission and outcome of radiography.

RESULTS

Six-month and 12-month followup data were available for 491 and 389 patients, respectively. At 6 months, 47.0% of patients achieved DAS28 remission, 57.6% had a good EULAR response, and 32.0% satisfied the ACR remission criteria. At 12 months, 58.1% of patients achieved DAS28 remission, 67.9% had a good EULAR response, and 46.4% achieved ACR remission. The median time to first remission was 25.3 weeks (interquartile range 13.0-52.0). The majority of patients did not have clinically relevant radiographic progression after 1 year.

CONCLUSION

The successful implementation of this treat-to-target strategy aiming at remission demonstrated that achieving remission in daily clinical practice is a realistic goal.

Authors+Show Affiliations

Arthritis Center Twente, Department of Psychology, Health and Technology, Faculty of Behavioural Sciences, University of Twente and Medisch Spectrum Twente, Enschede, The Netherlands. m.vermeer@gw.utwente.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21647867

Citation

Vermeer, Marloes, et al. "Implementation of a Treat-to-target Strategy in Very Early Rheumatoid Arthritis: Results of the Dutch Rheumatoid Arthritis Monitoring Remission Induction Cohort Study." Arthritis and Rheumatism, vol. 63, no. 10, 2011, pp. 2865-72.
Vermeer M, Kuper HH, Hoekstra M, et al. Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Arthritis Rheum. 2011;63(10):2865-72.
Vermeer, M., Kuper, H. H., Hoekstra, M., Haagsma, C. J., Posthumus, M. D., Brus, H. L., van Riel, P. L., & van de Laar, M. A. (2011). Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Arthritis and Rheumatism, 63(10), 2865-72. https://doi.org/10.1002/art.30494
Vermeer M, et al. Implementation of a Treat-to-target Strategy in Very Early Rheumatoid Arthritis: Results of the Dutch Rheumatoid Arthritis Monitoring Remission Induction Cohort Study. Arthritis Rheum. 2011;63(10):2865-72. PubMed PMID: 21647867.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. AU - Vermeer,Marloes, AU - Kuper,Hillechiena H, AU - Hoekstra,Monique, AU - Haagsma,Cees J, AU - Posthumus,Marcel D, AU - Brus,Herman L M, AU - van Riel,Piet L C M, AU - van de Laar,Mart A F J, PY - 2011/6/8/entrez PY - 2011/6/8/pubmed PY - 2013/1/26/medline SP - 2865 EP - 72 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 63 IS - 10 N2 - OBJECTIVE: Clinical remission is the ultimate therapeutic goal in rheumatoid arthritis (RA). Although clinical trials have proven this to be a realistic goal, the concept of targeting at remission has not yet been implemented. The objective of this study was to develop, implement, and evaluate a treat-to-target strategy aimed at achieving remission in very early RA in daily clinical practice. METHODS: Five hundred thirty-four patients with a clinical diagnosis of very early RA were included in the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Treatment adjustments were based on the Disease Activity Score in 28 joints (DAS28), aiming at a DAS28 of <2.6 (methotrexate, followed by the addition of sulfasalazine, and exchange of sulfasalazine with biologic agents in case of persistent disease activity). The primary outcome was disease activity after 6 months and 12 months of followup, according to the DAS28, the European League Against Rheumatism (EULAR) response criteria, and the modified American College of Rheumatology (ACR) remission criteria. Secondary outcomes were time to first DAS28 remission and outcome of radiography. RESULTS: Six-month and 12-month followup data were available for 491 and 389 patients, respectively. At 6 months, 47.0% of patients achieved DAS28 remission, 57.6% had a good EULAR response, and 32.0% satisfied the ACR remission criteria. At 12 months, 58.1% of patients achieved DAS28 remission, 67.9% had a good EULAR response, and 46.4% achieved ACR remission. The median time to first remission was 25.3 weeks (interquartile range 13.0-52.0). The majority of patients did not have clinically relevant radiographic progression after 1 year. CONCLUSION: The successful implementation of this treat-to-target strategy aiming at remission demonstrated that achieving remission in daily clinical practice is a realistic goal. SN - 1529-0131 UR - https://www.unboundmedicine.com/medline/citation/21647867/Implementation_of_a_treat_to_target_strategy_in_very_early_rheumatoid_arthritis:_results_of_the_Dutch_Rheumatoid_Arthritis_Monitoring_remission_induction_cohort_study_ L2 - https://doi.org/10.1002/art.30494 DB - PRIME DP - Unbound Medicine ER -