Rheumatoid arthritis

T2T is ‘feasible’ in clinical practice: study


A treat-to-target approach in RA patients is feasible in clinical practice say researchers who found a deviation from the treatment protocol occurred in just one quarter of clinic visits.

The retrospective cohort study involved treatment-naïve patients with RA of less than one year’s duration who attended a dedicated early arthritis clinic between 2001 and 2013.

Patients were followed for three years from initiation of combination therapy with conventional DMARDs which was subsequently modified according to a T2T protocol.

From a total of 198 patients and 3,654 clinic visits the researchers from Adelaide found a deviation from a T2T protocol occurred in one quarter of clinic visits.

Continuing existing treatment rather than intensifying therapy was the most common type of deviation (59.9%), the researchers reported in Arthritis and Therapy.

Patient and physician related factors were the most common reasons for deviation, each accounting for 24.7% of deviations. This was followed by toxicities (23.3%) and comorbidities (20.0%) which the authors said was “justifiable on clinical grounds”.

The prevalence of protocol deviations was lower among patients who achieved remission after three years (13.1%; 162 deviations out of 1,228 visits) compared with those who were not in remission (30.9%; 523/1692) (P <0.0001).

“It may be difficult in practice to strictly comply with rigid T2T principles given the heterogeneity of patient populations and a tendency to individualise the approach,” the researchers noted. 

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