Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort

被引:70
|
作者
Vermeer, Marloes [1 ,2 ]
Kuper, Hillechiena H. [2 ]
Moens, Hein J. Bernelot [3 ]
Hoekstra, Monique [4 ]
Posthumus, Marcel D. [5 ]
van Riel, Piet L. C. M. [6 ]
van de Laar, Mart A. F. J. [1 ,2 ]
机构
[1] Univ Twente, Dept Psychol Hlth & Technol, Arthrit Ctr Twente, NL-7500 AE Enschede, Netherlands
[2] Dept Rheumatol & Clin Immunol, NL-7500 KA Enschede, Netherlands
[3] Ziekenhuisgrp Twente, Dept Rheumatol, NL-7550 AM Hengelo, Netherlands
[4] Isala Klin, Dept Rheumatol, NL-8000 GM Zwolle, Netherlands
[5] Univ Groningen, Univ Med Ctr Groningen, Dept Rheumatol & Clin Immunol, NL-9700 RB Groningen, Netherlands
[6] Radboud Univ Nijmegen, Med Ctr, Dept Rheumatol, NL-6500 HB Nijmegen, Netherlands
关键词
DAILY CLINICAL-PRACTICE; DISEASE-ACTIVITY; AMERICAN-COLLEGE; TIGHT CONTROL; 28-JOINT COUNTS; ESCALATE CARE; RHEUMATOLOGISTS; RECOMMENDATIONS; TRIALS; DAS28;
D O I
10.1186/ar4099
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Clinical trials have demonstrated that treatment-to-target (T2T) is effective in achieving remission in early rheumatoid arthritis (RA). However, the concept of T2T has not been fully implemented yet and the question is whether a T2T strategy is feasible in daily clinical practice. The objective of the study was to evaluate the adherence to a T2T strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6) in early RA in daily practice. The recommendations regarding T2T included regular assessment of the DAS28 and advice regarding DAS28-driven treatment adjustments. Methods: A medical chart review was performed among a random sample of 100 RA patients of the DREAM remission induction cohort. At all scheduled visits, it was determined whether the clinical decisions were compliant to the T2T recommendations. Results: The 100 patients contributed to a total of 1,115 visits. The DAS28 was available in 97.9% (1,092/1,115) of the visits, of which the DAS28 was assessed at a frequency of at least every three months in 88.3% (964/1,092). Adherence to the treatment advice was observed in 69.3% (757/1,092) of the visits. In case of non-adherence when remission was present (19.5%, 108/553), most frequently medication was tapered off or discontinued when it should have been continued (7.2%, 40/553) or treatment was continued when it should have been tapered off or discontinued (6.2%, 34/553). In case of non-adherence when remission was absent (42.1%, 227/539), most frequently medication was not intensified when an intensification step should have been taken (34.9%, 188/539). The main reason for non-adherence was discordance between disease activity status according to the rheumatologist and DAS28. Conclusions: The recommendations regarding T2T were successfully implemented and high adherence was observed. This demonstrates that a T2T strategy is feasible in RA in daily clinical practice.
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页数:9
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