Switching first-line targeted therapy after not reaching low disease activity within 6 months is superior to conservative approach: a propensity score-matched analysis from the ATTRA registry
Autor: | Jakub Zavada, Lucie Nekvindová, Karel Pavelka, Zlatuše Křístková, Jiří Vencovský, Pavel Horák |
---|---|
Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Registry lcsh:Diseases of the musculoskeletal system Propensity score medicine.medical_treatment Logistic regression Severity of Illness Index Targeted therapy Odds 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Registries Rheumatoid arthritis 030203 arthritis & rheumatology business.industry Remission Induction Odds ratio medicine.disease Rheumatology Treatment Outcome Antirheumatic Agents Cohort Propensity score matching lcsh:RC925-935 business Treat-to-target Research Article |
Zdroj: | Arthritis Research & Therapy Arthritis Research & Therapy, Vol 23, Iss 1, Pp 1-10 (2021) |
ISSN: | 1478-6362 |
Popis: | BackgroundTreat-to-target (T2T) is a widely accepted strategy for patients with rheumatoid arthritis (RA). It recommends attaining a goal of at least low disease activity (LDA) within 6 months; otherwise, the current therapy should be modified. We aimed to investigate whether switching a first-line targeted therapy (TT) in patients not reaching LDA within 6 months leads to a higher probability of meeting LDA at the 12-month visit in daily clinical practice using data from Czech registry ATTRA.MethodsWe included patients with RA starting the first-line TT from 1 January 2012 to 31 January 2017 with at least 1-year follow-up. We created four mutually exclusive cohorts based on (1) switching to another TT within the first year and (2) reaching a treatment target (DAS28-ESR ≤ 3.2) at the 6-month visit. The primary outcome was the comparison of odds for reaching remission (REM) or LDA at the 12-month visit between patients switching and not switching TT after not reaching treatment target at 6 months. Before using logistic regression to estimate the odds ratio, we employed the propensity score to match patients at the 6-month visit.ResultsA total of 1275 patients were eligible for the analysis. Sixty-two patients switched within the first 5 months of the treatment before evaluating treatment response at the 6-month visit (C1); 598 patients reached the treatment target within 6 months of therapy (C2); 124 patients did not reach treatment response at 6-month visit and switched to another therapy (C3), and 491 patients continued with the same treatment despite not reaching LDA at the 6-month visit (C4). We matched 75 patients from cohort C3 and 75 patients from C4 using the propensity score. Patients following the T2T principle (C3) showed 2.8 (95% CI 1.4–5.8;p = 0.005) times increased likelihood of achieving REM/LDA at the 12-month visit compared to patients not following the T2T strategy (C4).ConclusionsIn daily clinical practice, the application of the T2T strategy is underused. Switching TT after not reaching REM/LDA within the first 6 months leads to a higher probability of achieving REM/LDA in RA patients at the 12-month visit. |
Databáze: | OpenAIRE |
Externí odkaz: |