Treating to Target in Clinical Practice: The Results of a Questionnaire Completed by Greek Rheumatologists

Overview

Journal Mediterr J Rheumatol

Specialty Rheumatology

Date 2020 Jul 18

PMID 32676573

Authors

Theofilos-Diamantis Karatsourakis

Xenofon Baraliakos

Affiliations

Soon will be listed here.

Abstract

Background: The Treat-To-Target (TTT) approach is an important part of clinical practice in rheumatology. Although this approach is well structured in rheumatoid arthritis (RA) and data are accumulating in psoriatic arthritis (PsA) and axial spondyloarthritides (AxSpA), the systematic application of this process in clinical practice can be further improved to achieve better treatment outcomes.

Objective: The aim of this study was to present the perspective of clinical rheumatologists on how they evaluate disease activity, in what patient groups they regularly use treatment targets, and how they prioritize treatment targets in spondyloarthritides.

Methods: A questionnaire consisting of eight questions on the management of RA, PsA and AxSpA (4 focusing on the use of indexes when setting treatment targets, 2 on the frequency and the patient groups to which these are being applied, and 2 on the physician's priorities in managing different manifestations of the SpA spectrum) was completed by private practice and hospital-based rheumatologists.

Results: 160 rheumatologists completed the questionnaire. The majority use the formal composite indexes in clinical practice, certain items from these indexes, and patients' evaluation of the treatment intervention. Indexes are applied frequently in most patient groups, and the priorities of rheumatologists include both musculoskeletal manifestations, as well as the other clinical aspects of the SpA spectrum.

Conclusion: The results can contribute to the understanding of the adherence of rheumatologists to this TTT strategy.

References

Singh J, Guyatt G, Ogdie A, Gladman D, Deal C, Deodhar A . Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken). 2018; 71(1):2-29. PMC: 8265826. DOI: 10.1002/acr.23789. View

Aletaha D, Alasti F, Smolen J . Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point. Ann Rheum Dis. 2015; 75(8):1479-85. DOI: 10.1136/annrheumdis-2015-208324. View

Sfikakis P, Bournia V, Sidiropoulos P, Boumpas D, Drosos A, Kitas G . Biologic treatment for rheumatic disease: real-world big data analysis from the Greek country-wide prescription database. Clin Exp Rheumatol. 2017; 35(4):579-585. View

Wailoo A, Hock E, Stevenson M, Martyn-St James M, Rawdin A, Simpson E . The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2017; 21(71):1-258. PMC: 5733384. DOI: 10.3310/hta21710. View

Sieper J, Poddubnyy D . Axial spondyloarthritis. Lancet. 2017; 390(10089):73-84. DOI: 10.1016/S0140-6736(16)31591-4. View

Boubouchairopoulou N, Flouri I, Drosos A, Boki K, Settas L, Zisopoulos D . Treatment with the first TNF inhibitor in rheumatoid arthritis patients in the Hellenic Registry of Biologic Therapies improves quality of life especially in young patients with better baseline functional status. Clin Exp Rheumatol. 2016; 34(6):999-1005. View

Smolen J, Schols M, Braun J, Dougados M, FitzGerald O, Gladman D . Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2017; 77(1):3-17. PMC: 5754738. DOI: 10.1136/annrheumdis-2017-211734. View

Felson D, Smolen J, Wells G, Zhang B, van Tuyl L, Funovits J . American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis. 2011; 70(3):404-13. DOI: 10.1136/ard.2011.149765. View

Smolen J, Aletaha D . Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. Nat Rev Rheumatol. 2015; 11(5):276-89. DOI: 10.1038/nrrheum.2015.8. View

10.

Ward M, Deodhar A, Gensler L, Dubreuil M, Yu D, Khan M . 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019; 71(10):1599-1613. PMC: 6764882. DOI: 10.1002/art.41042. View

11.

Smolen J, Breedveld F, Burmester G, Bykerk V, Dougados M, Emery P . Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2015; 75(1):3-15. PMC: 4717393. DOI: 10.1136/annrheumdis-2015-207524. View

12.

Flouri I, Markatseli T, Boki K, Papadopoulos I, Skopouli F, Voulgari P . Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence. J Rheumatol. 2018; 45(6):785-794. DOI: 10.3899/jrheum.170477. View

13.

Flouri I, Markatseli T, Voulgari P, Boki K, Papadopoulos I, Settas L . Comparative effectiveness and survival of infliximab, adalimumab, and etanercept for rheumatoid arthritis patients in the Hellenic Registry of Biologics: Low rates of remission and 5-year drug survival. Semin Arthritis Rheum. 2013; 43(4):447-57. DOI: 10.1016/j.semarthrit.2013.07.011. View

14.

Tucker L, Ye W, Coates L . Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target?. Curr Rheumatol Rep. 2018; 20(11):71. PMC: 6153572. DOI: 10.1007/s11926-018-0781-x. View

15.

Baraliakos X, Berenbaum F, Favalli E, Olivieri I, Ostendorf B, Poddubnyy D . Challenges and Advances in Targeting Remission in Axial Spondyloarthritis. J Rheumatol. 2018; 45(2):153-157. DOI: 10.3899/jrheum.170222. View

16.

Thomas K, Lazarini A, Kaltsonoudis E, Drosos A, Papalopoulos I, Sidiropoulos P . Multicenter Cross-sectional Study of Patients with Rheumatoid Arthritis in Greece: Results from a cohort of 2.491 patients. Mediterr J Rheumatol. 2020; 29(1):27-37. PMC: 7045959. DOI: 10.31138/mjr.29.1.27. View