Dr. Pope has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Amgen, Pfizer, Roche, Janssen, BMS, and UCB.
Treating to a Target in Established Active Rheumatoid Arthritis Patients Receiving a Tumor Necrosis Factor Inhibitor: Results From a Real-World Cluster-Randomized Adalimumab Trial
Article first published online: 26 AUG 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 9, pages 1401–1409, September 2013
How to Cite
Pope, J. E., Haraoui, B., Rampakakis, E., Psaradellis, E., Thorne, C., Sampalis, J. S. and on behalf of the Optimization of Adalimumab Trial Investigators (2013), Treating to a Target in Established Active Rheumatoid Arthritis Patients Receiving a Tumor Necrosis Factor Inhibitor: Results From a Real-World Cluster-Randomized Adalimumab Trial. Arthritis Care Res, 65: 1401–1409. doi: 10.1002/acr.22010
ClinicalTrials.gov identifier: NCT01585064.
Investigators for the Optimization of Adalimumab Trial are shown in Appendix A.
- Issue published online: 26 AUG 2013
- Article first published online: 26 AUG 2013
- Accepted manuscript online: 18 MAR 2013 02:43PM EST
- Manuscript Accepted: 4 MAR 2013
- Manuscript Received: 6 AUG 2012
In early rheumatoid arthritis (RA), treating to a target is more effective than routine care (RC). Our aim was to determine if treating to a target has better outcomes than RC in established active RA.
We used a real-world, 18-month cluster-randomized trial in established active RA patients treated with adalimumab. Physicians were randomized to RC, treating to a Disease Activity Score in 28 joints (DAS28) of <2.6 (DAS group), or treating to a 0 of 28 swollen joint count (SJC; 0-SJC group).
Among the 308 enrolled patients, 109 (35.4%) were randomized to RC, 100 (32.5%) to the DAS group, and 99 (32.1%) to the 0-SJC group. When adjusting for baseline DAS28, a comparable but significant (P < 0.001) improvement in DAS28 was observed at 12 months for all groups (DAS28 mean score 3.1, 3.4, and 3.2, respectively). There were no significant between-group differences in the improvement of clinical parameters and patient-reported outcomes with the exception of the mean change in patient satisfaction over time (P = 0.020), which was highest in the DAS group. Time to achieving good/moderate European League Against Rheumatism (EULAR) response was significantly shorter in the targeted treatment groups compared to RC (adjusted hazard ratio [HR] for the DAS-group 2.99 [95% confidence interval (95% CI) 1.71–5.24] and HR for the 0-SJC group 1.86 [95% CI 1.09–3.13]). The dropout rate was 52.3% in RC, 27% in the DAS group, and 22.2% in the 0-SJC group (P < 0.001).
All groups experienced significant improvements at 18 months of treatment with adalimumab. Treating to target in established RA did not differ from RC in terms of therapeutic end point achievement for patients remaining on treatment. However, time to achieving good/moderate EULAR response was significantly shorter in the targeted treatment groups compared to RC and, importantly, the dropout rate was significantly lower with targeted treatment.