Adherence to treat-to-target management in rheumatoid arthritis and associated factors: Data from the international RA BIODAM cohort

Alexandre Sepriano, Sofia Ramiro, Oliver FitzGerald, Mikkel Østergaard, Joanne Homik, Désirée Van Der Heijde, Ori Elkayam, J. Carter Thorne, Maggie J. Larché, Gianfranco Ferraccioli, Marina Backhaus, Gerd R. Burmester, Gilles Boire, Bernard Combe, Thierry Schaeverbeke, Alain Saraux, Maxime Dougados, Maurizio Rossini, Marcello Govoni, Luigi SinigagliaAlain Cantagrel, Cheryl Barnabe, Clifton O. Bingham, Paul P. Tak, Dirkjan Van Schaardenburg, Hilde Berner Hammer, Joel Paschke, Rana Dadashova, Edna Hutchings, Robert Landewé, Walter P. Maksymowych

Research output: Contribution to journalArticlepeer-review


Objective. Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T. Methods. Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model). Results. A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02-1.19), smoking (OR 1.32, 95% CI 1.08-1.63) and high number of tender joints (OR 1.03, 95% CI 1.02-1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50-0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model. Conclusion. Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features.

Original languageEnglish (US)
Pages (from-to)809-819
Number of pages11
JournalJournal of Rheumatology
Issue number6
StatePublished - Jun 1 2020


  • Best treatment practices
  • Rheumatoid arthritis
  • Treat-to-target

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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