Background/Purpose: The
approach of setting disease activity targets and adjusting therapy
appropriately to achieve the target has been proven to optimize outcomes in
Rheumatoid Arthritis (RA). Target setting is not yet universal and targets may
evolve with rheumatologists’ increasing understanding of the patient’s RA and
their response to treatment over time.

Methods: Data
were drawn from the Adelphi 2014 Rheumatology Disease Specific Programme, a
survey of rheumatologists and their RA patients in France, Germany, Italy,
Spain and the UK. Rheumatologists provided patient demographics, details of
treat to target (T2T) approach (if any), satisfaction with RA control and time
since RA diagnosis. Patients were allocated to one of two cohorts based on time
since RA diagnosis: <2 years, ≥2 years. The cohorts were compared
on the T2T approach the treating rheumatologist had reported: aspirational (T2T
goal stated as remission), pragmatic (T2T goal stated as something other than
remission), T2T approach not adopted for the patient. The level of physician
satisfaction with RA control was compared across the T2T approaches within each
cohort. Appropriate univariate tests were performed to assess for statistically
significant associations, nominal p values were reported.

Results: 307
rheumatologists provided data for 2,536 patients, of whom 2,381 had a time
since diagnosis reported (mean age: 52.5; 71% female). 24.3% (579 patients) of
patients had been diagnosed with RA <2 years ago and the remaining 75.7% (1,802
patients) diagnosed ≥ 2 years ago. Physicians had a T2T approach with
no target, pragmatic target and aspirational target in 48.0%, 16.6% and 35.4%
respectively.

Patients with a shorter time since diagnosis (<2 years)
were more likely than patients with a longer time since diagnosis to have no
target (57.9% vs. 44.9% respectively; p<0.0001) and less likely to have a
pragmatic target (7.8% vs. 19.4%; p<0.0001). Levels of aspirational targets
were similar regardless of the duration since diagnosis (34.4% vs. 35.7%).  

Physician satisfaction with RA control was lower in
patients with a shorter time since diagnosis (65.1% vs. 77.0%; p<0.0001). In
these patients with a shorter time since diagnosis, satisfaction by T2T
approach was 56.3%, 64.4%, 70.4%, for aspirational, pragmatic and no target
respectively. In patients with a longer diagnosis, satisfaction by T2T approach
was 82.4%, 62.9%, 78.7%, for aspirational, pragmatic and no target respectively
(p<0.0001).

Conclusion:
This research shows that a T2T approach
is not used for almost half RA patients, although use of T2T is more common
among those who have been diagnosed ≥2 years ago. The satisfaction
level with disease control is also higher in these patients. However, the
higher use of pragmatic T2T approaches in patients with longer disease duration
suggests that current treatment options may not comprehensively succeed in
meeting the early aspirations of remission for RA patients.