@article{2a9bafe8e7b34dfbb7c48806296f35a0,
title = "Cluster-Randomized Trial of a Behavioral Intervention to Incorporate a Treat-to-Target Approach to Care of US Patients With Rheumatoid Arthritis",
abstract = "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.",
author = "Harrold, {Leslie R.} and Reed, {George W.} and Ani John and Barr, {Christine J.} and Kevin Soe and Robert Magner and Saunders, {Katherine C.} and Ruderman, {Eric M.} and Tmirah Haselkorn and Greenberg, {Jeffrey D.} and Allan Gibofsky and Harrington, {J. Timothy} and Kremer, {Joel M.}",
note = "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, Funding Information: Support for third-party writing assistance for this manuscript, furnished by Elizabeth Ohneck of Health Interactions, was provided by F. Hoffmann-La Roche.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: 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. Publisher Copyright: {\textcopyright} 2017, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.",
year = "2018",
month = mar,
doi = "10.1002/acr.23294",
language = "English (US)",
volume = "70",
pages = "379--387",
journal = "Arthritis Care and Research",
issn = "2151-464X",
publisher = "John Wiley & Sons Inc.",
number = "3",
}