@article{Sepriano2019, abstract = {Objective.Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T.Methods.Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model).Results.A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02–1.19), smoking (OR 1.32, 95% CI 1.08–1.63) and high number of tender joints (OR 1.03, 95% CI 1.02–1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50–0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model.Conclusion.Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].}, author = {Sepriano, Alexandre and Ramiro, Sofia and FitzGerald, Oliver and Østergaard, Mikkel and Homik, Joanne and van der Heijde, Désirée and Elkayam, Ori and Thorne, J. Carter and Larché, Maggie J. and Ferraccioli, Gianfranco and Backhaus, Marina and Burmester, Gerd R. and Boire, Gilles and Combe, Bernard and Schaeverbeke, Thierry and Saraux, Alain and Dougados, Maxime and Rossini, Maurizio and Govoni, Marcello and Sinigaglia, Luigi and Cantagrel, Alain and Barnabe, Cheryl and Bingham, Clifton O. and Tak, Paul P. and van Schaardenburg, Dirkjan and Berner Hammer, Hilde and Hammer, Hilde Berner and Paschke, Joel and Dadashova, Rana and Hutchings, Edna and Landewé, Robert and Maksymowych, Walter P.}, doi = {10.3899/jrheum.190303}, journal = {The Journal of Rheumatology}, month = {sep}, pages = {809-819}, title = {Adherence to Treat-to-target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort}, url = {https://oadoi.org/10.3899/jrheum.190303}, volume = {47}, year = {2019} }