Background/Purpose: Treat to Target (T2T) primary principal – “The treatment of rheumatoid arthritis must be based on a shared decision between patient and rheumatologist”. Japan uses T2T, but its impact on patients is not yet clear. To better understand T2T implementation, a large scale survey was conducted using a multi-cohort study.

Methods: A survey was given to 4489 RA outpatients in multiple facilities in Japan; contents included; age, gender, medical history, and comments on; 1) things to know before administration, 2) expectations of medication, 3) disappointment with medication, 4) anxiety switching medication 5) biologics experience, 6) goals for treatment, 7) satisfaction level, 8) questions and expectation of doctors, 9) treatment fees, 10) impression of biologics, 11) injections, 12) desires for the future. For further analysis the total results from respondents were divided into 2 groups; Biologics (BG), 1728 patients, and DMARDs Group (DG), 2264 patients.

Results: Eighty-two point five percent of the respondents were female and 27% had disease duration of 10-20 years. Usage; DG 80% BG, 35%. For ‘expectations of medication’, 35% responded with ‘assured improvement of the condition’ while 22% responded ‘reduced destruction or deformation of joints’; no difference between groups. In BG more patients (22%) hoped for long-lasting efficacy than in DG (14%). ‘Experience of disappointment’ was 22% in total, but the rate of BG was twice that of DG; reason for disappointment for BG was lack of efficacy, however, for DG it was adverse events. The reason for ‘anxiety when switching’ was mainly ‘adverse events’ and ‘efficacy’ in both groups, but ‘diminishing efficacy’ showed a higher rate in BG, related with the reason for disappointment. In both groups the ‘goals for treatment’ was mostly ‘the improvement of QOL’ and ‘reduced destruction/deformation of joints’, but ‘reduced destruction/deformation of joints’ for BG were 1.5 times that of DG. BG wanted more information about future treatment. In DG, 70% were willing to spend up to ¥10,000 a month, as opposed to 30% in BG, suggesting BG understood the cost of biologics. For injections, many in both groups, responded ‘troublesome’ or ‘frightening’, but the image was higher for self-injection, especially in DG, but, half the respondents in BG chose ‘convenient’.

Conclusion: Expectations for medication in terms of assured improvement of conditions and prevention for joint destruction, were confirmed with results of a single-institution study 2 years ago. But, rate of ‘long-lasting efficacy of drugs’ was higher in BG this time. Data indicated BG showed these tendencies after secondary failure, which was also suggested in both studies. The patients in BG, due to knowledge of prevention of joint destruction, have higher treatment goals than DG. The comparison between 2 groups indicated once patients experience high efficacy, they can tolerate self-injection and higher fees. We should be aware that what Japanese RA patients are expecting is assured improvement of condition including prevention from joint destruction and long-lasting efficacy. Our study indicates steady implementation of T2T while patients are receiving good education, clearly understanding 3 standards for remission of RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/expectations-ra-patients-have-for-their-treatment-a-comparison-of-clinical-results-for-biologic-and-disease-modifying-anti-rheumatic-drug-treated-patients-using-multiple-medical-cohorts/