TY - JOUR
T1 - Cluster-Randomized Trial of a Behavioral Intervention to Incorporate a Treat-to-Target Approach to Care of US Patients With Rheumatoid Arthritis
AU - Harrold, Leslie R.
AU - Reed, George W.
AU - John, Ani
AU - Barr, Christine J.
AU - Soe, Kevin
AU - Magner, Robert
AU - Saunders, Katherine C.
AU - Ruderman, Eric M.
AU - Haselkorn, Tmirah
AU - Greenberg, Jeffrey D.
AU - Gibofsky, Allan
AU - Harrington, J. Timothy
AU - Kremer, Joel M.
N1 - Funding Information:
The Consortium of Rheumatology Researchers of North America (CORRONA) treat-to-target study is sponsored by CORRONA, LLC, with support from a development and subscription agreement/contract with Genentech and additional support from AbbVie. The CORRONA RA registry has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, BMS, Crescendo, Genentech, Horizon Pharma USA, Janssen, Eli Lilly, Novartis, Pfizer, and UCB.
Funding Information:
received research support from Pfizer. Dr. Reed holds shares in CORRONA. Dr. Ruderman has received consulting fees from Amgen, AbbVie, Janssen, Eli Lilly, Novartis, Roche, and Seattle Genetics (less than $10,000 each) and from Pfizer (more than $10,000). Dr. Haselkorn has received consulting fees from Genentech (less than $10,000). Dr. Greenberg holds shares in CORRONA, and has received consulting fees from Eli Lilly, Genentech, Janssen, Novartis, and Pfizer (less than $10,000 each). Dr. Gibofsky holds shares in AbbVie, Amgen, Johnson & Johnson, and Pfizer, and has received consulting fees from AbbVie, Celgene, Eli Lilly, Medec, Novartis, Relbum, Pfizer,
PY - 2018/3
Y1 - 2018/3
N2 - Objective: To assess the feasibility and efficacy of implementing a treat-to-target approach versus usual care in a US-based cohort of rheumatoid arthritis patients. Methods: In 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. Results: A 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. Conclusion: This 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.
AB - Objective: To assess the feasibility and efficacy of implementing a treat-to-target approach versus usual care in a US-based cohort of rheumatoid arthritis patients. Methods: In 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. Results: A 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. Conclusion: This 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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U2 - 10.1002/acr.23294
DO - 10.1002/acr.23294
M3 - Article
C2 - 28544704
AN - SCOPUS:85041578642
VL - 70
SP - 379
EP - 387
JO - Arthritis Care and Research
JF - Arthritis Care and Research
SN - 2151-464X
IS - 3
ER -