Background/Purpose: The aim of this analysis was to compare between enrolment periods RA treatment outcomes and frequency of treating to target, and to assess the impact of target type on long-term function.

Methods: This is a post-hoc analysis of data from the Biologic Treatment Registry Across Canada (BioTRAC). Patients with RA who initiated treatment with infliximab or subcutaneous golimumab were included. Patients were grouped into enrolment periods: 2002-2004, 2005-2008, 2009-2012, 2013-2015, 2016-2017. Achievement of LDA (CDAI LDA or SDAI LDA or SJC≤1), remission (CDAI remission or SDAI remission or SJC=0), and sustained LDA or remission (at 6 and 12 months) were compared between enrolment periods with the Chi-square test and multivariate logistic regression. The impact of achieving LDA or remission at 6 months, 12 months, or both (sustained) on HAQ-DI at 18 months was assessed with one-way ANOVA and generalized linear models.

Results: 1420 patients treated with anti-TNFs (IFX: n=890; GLM: n=530) were included. Over calendar time, a significant decrease in baseline disease duration and disease activity scores (CDAI, SDAI, SJC28, TJC28, HAQ) was observed (p < 0.001).

Across enrolment periods, significant differences were observed in target achievement with higher rates observed in more recent years. Upon adjusting for baseline CDAI and prior biologic exposure, no differences between enrolment periods were observed in achieving LDA, remission or sustained LDA/remission at 6 months; however, significantly (p=0.030) higher odds of achieving remission at 12 months were observed in more recent years.

Among patients not achieving LDA at 6 and 12 months, an intervention was applied in approximately 40% of patients, without significant differences between enrolment periods. Between 6 and 12 months, the most common intervention was anti-TNF discontinuation (64.9% of non-LDA achievers), followed by DMARD addition (9.8%), NSAID addition (8.8%), or steroid addition (7.2%). Similar results were obtained post 12 months.

Patients achieving sustained LDA, followed by those achieving LDA either at 6 or 12 months had significantly lower HAQ-DI at 18 months compared to patients not achieving LDA at either timepoint (0.8 vs. 1.1 vs. 1.4; p< 0.001). Similar results were observed when evaluating achievement of disease remission albeit with greater impact on HAQ-DI at 18 months (0.7 vs. 1.1 vs. 1.2; p< 0.001). Adjustment for baseline HAQ-DI did not impact the results.

Conclusion: Target achievement has increased over time although emphasis in treating to target may be placed in the first 6 months of treatment. Achieving stricter targets was associated with better long-term patient function.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/application-of-treat-to-target-and-impact-of-sustained-low-disease-activity-or-remission-on-function-in-rheumatoid-arthritis-patients/