No increased adverse events, health care use in treat-to-target strategies for RA
Implementing treat-to-target strategies for rheumatoid arthritis increases neither adverse events nor health care use, according to a post-hoc analysis published in Arthritis Care & Research.
“After finding that we were able to improve adherence with treat-to-target through a learning collaborative, we felt that it was critical to determine if treating to target was associated with more resource use and/or more adverse events,” Daniel H. Solomon, MD, MPH, of Brigham and Women’s Hospital, told Healio Rheumatology. “In other clinical areas, the implementation of a treat-to-target paradigm has been associated with an increase in adverse events.”
To evaluate adverse effects and medical resource use both during and prior to initiation of treat to target among patients with RA, the researchers examined six rheumatology practice sites in the United States that were part of a cluster-randomized controlled trial aimed at improving implementation of treat-to-target strategies. For their analysis, Solomon and colleagues compared adverse events and medical resource use during two time periods — the 9 months before treat-to-target initiation, and the 9 months during the intervention.
The researchers examined the records of 321 patients prior to initiation and 315 during the treat-to-target intervention. All participants were chosen randomly by the rheumatology practice sites. Reported outcomes included adverse events and resource use based on a medical record review of all rheumatology visits for RA before and during the intervention.
According to the researchers, adverse events were reported in 10.2% of visits before treat-to-target, and in 8.8% during the intervention (P = .41). In addition, 53.6% of patients used biologic disease-modifying antirheumatic drugs before the intervention, with 49.8% using them during the intervention (P = .73). Patients examined prior to initiation recorded more frequent rheumatology visits, with a mean of 4 ± 1.4, compared with those studied during the intervention, who recorded a mean 3.6 ± 1.2 visits (P = .02).
In addition, 90% of rheumatology practice visits included monitoring laboratory tests prior to the intervention, compared with 52.7% during treat-to-target (P < .001). Similarly, more visits before the intervention included diagnostic imaging than during the intervention (P < .001).
“We found that treat-to-target was not associated with excess resource use or excess adverse events,” Solomon said. “This should give clinicians and health systems greater confidence to pursue implementation of treat-to-target in rheumatoid arthritis.” – by Jason Laday
Disclosure: Solomon reports grant support from Amgen, Pfizer, BMS, Genentech and Abbvie. Please see the study for all other authors’ relevant financial disclosures.