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Deep dive into achieving the therapeutic target: results from a prospective, 6-month, observational study nested in routine rheumatoid arthritis care.

INTRODUCTION
Achieving of remission or low-disease activity (LDA) is an integral principle of treat-to-target (T2T) strategy in rheumatoid arthritis (RA). Prior studies have reported that achieving T2T therapy goals may be realistic only for a fraction of patients. Prospective, real-world data on achieving target disease control in ambulatory care populations are limited for Central and Eastern European countries.


PATIENTS AND METHODS
We designed a multicentre study to analyse the efficacy of treatment and determine simple predictors of achieving T2T therapy goals in daily RA practice. A multicentre, six-month study evaluating therapy outcomes and clinical characteristics of 780 consecutive RA outpatients, meeting pre-set criteria of inadequate disease control, was conducted.


RESULTS
Only 9% of RA patients achieved remission or low-disease activity by three-months and 35% by six-months. Achieving treatment targets by six months was associated with lower rates of pain, disability, presenteeism and absenteeism, which reflects improved quality of life. Provider views on adherence appear discordant with patient claims and do not predict target achievement. Smoking, body mass index and lower prednisone dose (<7.5 mg daily) are independently associated with a higher likelihood of achieving T2T therapy goals by six months.


CONCLUSIONS
A combination of clinical characteristics and provider treatment decisions shapes the "profile" of a patient failing to achieve T2T goals. Low-dose steroid equivalent, smoking and body-mass index appear as individual characteristics independently associated with achieving LDA / remission at three and six months.