Table 1.
Overview of observational studies with relevance to treat-to-target (T2T) adherence among physicians.
| Reference | Design | Characteristics | Population (n) | Follow-Up | Study Aim(s) | Outcome(s) | Key Findings |
|---|---|---|---|---|---|---|---|
| Vermeer et al., 2012, Arthritis Res Ther [29] | longitudinal, observational multicenter (DREAM cohort) | early RA, DMARD naïve | 100 | 28 m | Medical chart review to assess T2T; systematic monitoring with DAS28 and following treatment advice, evaluating deviations, and reasons for nonadherence | (i) visits when DAS28 was determined (ii) visits when therapy was adjusted accordingly to advice (remission yes/no) (iii) most frequent deviation from medication advice (remission yes/no) |
(i) 98% of total visits had DAS28, of these 88% agreed with T2T monitoring (ii) 69% of total visits, with remission 80% followed, w/o 58% (iii) tapered/discontinued when it should be continued (remission), no intensification (non-remission) |
| Escalas et al., 2012, Ann Rheum Dis [37] | longitudinal, observational multicenter (ESPOIR cohort) | early RA, DMARD naïve | 782 | 24 m | Adherence to 2007 EULAR guidelines and impact on radiographic progression and functional ability | (i) DMARDS in patients at risk of erosive/persistent disease (ii) MTX as first DMARD (iii) remission is target and regular monitoring should drive treatment strategy |
For (i–iii), adherence was 78%, 67%, and 52%, respectively, for all three 23%, w/o adherence: OR 1.98; 95% CI 1.08–3.62 for radiographic progression, OR 2.36; 95% CI 1.17–4.67 for increase in HAQ ≥1 at 2 y |
| Wabe et al., 2015, Int J Rheum Dis [23] | single-center, longitudinal | early RA, DMARD naïve | 149 | 36 m | Extent of compliance with T2T strategy necessary to achieve optimal rates of good response at visits | (i) treatment decisions compliant with T2T protocol (ii) cut-off for good outcome at y 3 (iii) cut-off for worse outcome at y 3 |
(i) 76% of visits (ii) 81% compliance for DAS28 remission and 71% for LDA (iii) remission and LDA are unlikely if physician compliance <70% |
| Lesuis et al., 2016, RMD Open [16] | single-center, retrospective | early and longstanding RA | 137 | 12 m | (i) guideline adherence in standard care (ii) variation in adherence on parameter and rheumatologist level (iii) predictors for adherence |
7 dichotomous guideline adherence parameters (diagnostics, treatment, follow-up and shared care), guideline adherence on patient and visit level, determinants on patient and provider level | (i–ii) therapy change in active disease —67%, regular outpatient visits with DAS28 assessment—37%, correct interval between outpatient visit—32% (ii) variation among rheumatologist interval of visit—11–43% (iii) several rheumatologist and patient-related factors impact guideline adherence (see reference for details) |
| Xie et al., 2018, Clin Exp Rheumatol [38] | single-center, retrospective | early and longstanding RA, proportion treatment naïve | 704 | 12 m | Sub-cohort trend analyses for first clinic visit prior to and after 2011, comparison with composite indices | Trends in RA control prior to and after publication of guidelines | Higher proportion of pts with low-disease activity and remission in T2T. Visit frequency in all disease activity stages increased after T2T with higher rate of regular follow-up |
| Taylor et al., 2018, Patient Prefer Adherence [14] | cross-sectional, multinational, data from Adelphi 2014 Disease Specific Programme | early and longstanding RA | 2536 | N/A | Implementation of T2T in European centers when comparing pts with RA diagnosis <2 or ≥2 years | Applied strategy (i) no target (ii) target other than remission (iii) target set as remission |
Proportion of pts (%) treated with respective strategy in early RA (i) 58%, (ii) 8%, (iii) 34%, and longstanding RA (i) 45%, (ii) 19%, (iii) 36% |
(i) Abbreviations: Not applicable (N/A), rheumatoid arthritis (RA), disease activity score using 28-joint count (DAS28), patients (pts), low-disease activity (LDA), treat-to-target (T2T), year (y), month (m), Health Assessment Questionnaire (HAQ), Odds Ratio (OR), confidence interval (CI), European League Against Rheumatism (EULAR), Dutch Rheumatoid Arthritis Monitoring registry (DREAM), Etude et Suivi des Polyarthrites Indifferenciees Recentes (ESPOIR). (ii) Definitions of disease character vary across studies; if studies divided patients by RA course, we adopted a definition of early and longstanding RA where deemed appropriate.