Patient Perspectives on Achieving Treat-to-Target Goals: A Critical Examination of Patient-Reported Outcomes

Authors

  • Jeffrey R. Curtis,

    Corresponding author
    • University of Alabama at, Birmingham
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    • Dr. Curtis has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from AbbVie, BMS, Crescendo, and Pfizer and (more than $10,000 each) from Amgen, the Consortium of Rheumatology Researchers of North America (CORRONA), Janssen, Roche/Genentech, and UCB.

  • Ying Shan,

    1. University of Massachusetts Medical School, Worcester
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  • Leslie Harrold,

    1. University of Massachusetts Medical School, Worcester
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    • Dr. Harrold has received consultant fees (less than $10,000) from CORRONA.

  • Jie Zhang,

    1. University of Alabama at, Birmingham
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    • Dr. Zhang has received research grants from Amgen.

  • Jeffrey D. Greenberg,

    1. New York University School of Medicine, New York
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    • Dr. Greenberg has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from AstraZeneca and Pfizer and (more than $10,000) from CORRONA, and owns stock or stock options in CORRONA.

  • George W. Reed

    1. University of Massachusetts Medical School, Worcester
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    • Dr. Reed has received consultant fees (more than $10,000) from CORRONA.


510 20th Street South, Faculty Office Towers 802D, Birmingham, AL 35294. E-mail: jcurtis@uab.edu

Abstract

Objective

Treat-to-target (T2T) recommendations suggest that rheumatoid arthritis (RA) patients should strive for remission or low disease activity (LDA). However, it is unclear whether patients experiencing a good response to biologic agents might experience further improvement in patient-reported outcomes (PROs) if they subsequently achieve a lower disease activity state, particularly the T2T goals of LDA or remission.

Methods

Using the Consortium of Rheumatology Researchers of North America database, we identified RA patients initiating biologic agents. We restricted the analysis to patients with improvement (Clinical Disease Activity Index [CDAI] improvement of ≥10 units) at 3–6 months (baseline visit; n = 1,368) with a followup visit approximately 9 months later (n = 984). Patients in CDAI remission or with a worsened disease activity category were excluded, leaving 562 eligible patients. PROs (global assessment, pain, and fatigue by 0–10 visual analog scales and disability by the modified Health Assessment Questionnaire [M-HAQ]) were examined at these 2 visits. Mean change in PROs compared achievement of a lower disease activity category versus staying in the same disease activity category, adjusting for potential confounders.

Results

Patients who achieved a lower disease activity category (40% of the eligible cohort, 86% of these achieving LDA or remission) had significantly better improvement in patient pain (−14.9; 95% confidence interval [95% CI] −18.4, −11.6), patient global (−17.5; 95% CI −20.8, −14.3), fatigue (−8.5; 95% CI −15.8, −1.3), and M-HAQ score (−0.13; 95% CI −0.18, −0.08) compared to patients who stayed in the same disease activity category. However, even for patients improving, fewer than half exceeded the minimum clinically important difference for each PRO.

Conclusion

Achievement of a lower disease activity disease state, especially T2T goals, was associated with further improvement in PROs, albeit modest in magnitude.

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