Cluster‐Randomized Trial of a Behavioral Intervention to Incorporate a Treat‐to‐Target Approach to Care of US Patients With Rheumatoid Arthritis

Arthritis Care and Research - Tập 70 Số 3 - Trang 379-387 - 2018
Leslie R. Harrold1, George Reed1, Ani John2, Christine Barr3, Kevin Soe3, Robert Magner4, Katherine C. Saunders3, Eric Ruderman5, Tmirah Haselkorn2, Jeffrey D. Greenberg6, Allan Gibofsky7, J. Timothy Harrington8, Joel M. Kremer9
1University of Massachusetts Medical School, Worcester, and CORRONA, LLC, Waltham
2Genentech, South San Francisco, California
3CORRONA, LLC, Waltham, Massachusetts
4University of Massachusetts Medical School, Worcester, Massachusetts
5Northwestern University Feinberg School of Medicine, Chicago, Illinois
6New York University School of Medicine, New York
7Hospital for Special Surgery, New York, New York
8Harrington Consulting, LLC, Madison, Wisconsin
9Albany Medical College and The Center for Rheumatology, Albany, New York

Tóm tắt

ObjectiveTo assess the feasibility and efficacy of implementing a treat‐to‐target approach versus usual care in a US‐based cohort of rheumatoid arthritis patients.MethodsIn this behavioral intervention trial, rheumatology practices were cluster‐randomized to provide treat‐to‐target care or usual care. Eligible patients with moderate/high disease activity (Clinical Disease Activity Index [CDAI] score >10) were followed for 12 months. Both treat‐to‐target and usual care patients were seen every 3 months. Treat‐to‐target providers were to have monthly visits with treatment acceleration at a minimum of every 3 months in patients with CDAI score >10; additional visits and treatment acceleration were at the discretion of usual care providers and patients. Coprimary end points were feasibility, assessed by rate of treatment acceleration conditional on CDAI score >10, and achievement of low disease activity (LDA; CDAI score ≤10) by an intent‐to‐treat analysis.ResultsA total of 14 practice sites per study arm were included (246 patients receiving treat‐to‐target and 286 receiving usual care). The groups had similar baseline demographic and clinical characteristics. Rates of treatment acceleration (treat‐to‐target 47% versus usual care 50%; odds ratio [OR] 0.92 [95% confidence interval (95% CI) 0.64, 1.34]) and achievement of LDA (treat‐to‐target 57% versus usual care 55%; OR 1.05 [95% CI 0.60, 1.84]) were similar between groups. Treat‐to‐target providers reported patient reluctance and medication lag time as common barriers to treatment acceleration.ConclusionThis study is the first to examine the feasibility and efficacy of a treat‐to‐target approach in typical US rheumatology practice. Treat‐to‐target care was not associated with increased likelihood of treatment acceleration or achievement of LDA, and barriers to treatment acceleration were identified.

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Thông tin xuất bản

Arthritis Care and Research

Tập 70 Số 3

379-387

Thông tin tác giả