| Autor: |
Ferreira MF; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., Kohem CL; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., Xavier RM; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., Abegg E; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., Martins OS; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., Resmini MB; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., de Mello AL; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., de Almeida Menegat F; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., Hax V; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., Gasparin AA; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., Brenol CV; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., de Andrade NPB; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., Viecceli D; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil., Brenol JCT; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil., Palominos PE; Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil. penelopepalominos@gmail.com. |
| Abstrakt: |
The treat-to-target strategy (T2T) was associated with better outcomes in psoriatic arthritis (PsA) compared to standard care in clinical trials. This study aimed to analyze factors precluding treatment optimization in a T2T strategy conducted in a real-world cohort of PsA patients. A retrospective cross-sectional study nested in a cohort was conducted. Medical records of patients ≥ 18 years old, fulfilling CASPAR criteria and with at least one visit in the PsA clinic, were reviewed. Demographic data, current medication, and minimal disease activity (MDA) criteria were recorded. Reasons for the non-escalation of therapy in patients who were not classified as MDA were reported as absolute and relative frequencies. In the 8-month period, 131 visits (corresponding to 74 patients) were conducted. The MDA criteria were available in 113 visits (86.3%) and patients were classified as MDA in 31.0% of the visits (N = 35/113). Although in 69.0% of the visits patients were not in MDA, (N = 78/113), therapy was adjusted in only 42.3% (N = 33/78). Reasons precluding treatment escalation in non-MDA subjects were physician's impression of remission (57.7%, N = 26), non-adherence to previous prescription (17.8%, N = 8), restricted access to drugs (17.8%, N = 8), adverse events (11.1%, N = 5), poor understanding of medication instructions (6.7%, N = 3), patient's refusal to escalate therapy (4.4%, N = 2), and recent change in therapy (2.2%, N = 1). Discordance between the physician's clinical evaluation and the MDA criteria, non-adherence to prescription, and poor access to drugs were the main factors precluding escalation of therapy in a T2T strategy in a real-world PsA cohort. |
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