PMID- 28094760
OWN - NLM
STAT- MEDLINE
DCOM- 20170613
LR  - 20170613
IS  - 0392-856X (Print)
IS  - 0392-856X (Linking)
VI  - 35
IP  - 2
DP  - 2017 Mar-Apr
TI  - Treat-to-target biologic therapy in patients with rheumatoid arthritis is more 
      efficacious and safe compared to delayed initiation of biologics: a real-world 
      study.
PG  - 192-200
AB  - OBJECTIVES: Rheumatoid arthritis (RA) is a chronic, devastating disease. 
      Treat-to-target strategy (T2T) more than the usual care, reduces disease activity 
      by using aggressively all therapeutic options. The aim of the study was to 
      evaluate our hypothesis that T2T strategy using biologic disease-modifying 
      anti-rheumatic drugs (bDMARDs), when needed, is also safer than the usual care 
      characterised by delayed initiation of bDMARDs. METHODS: Disease activity was 
      regularly measured by DAS-28 until the end of treatment with the first bDMARD. 
      All adverse events (AEs) and their severity were recorded. Cox 
      proportional-hazards models were performed examining the association of treatment 
      groups, with the risk of first AE. RESULTS: There were 113 patients in T2T and 
      250 patients in usual care group. The likelihood (adjusted hazard ratio, HR) of 
      achieving remission or LDA was 71% higher in the T2T group than in the usual care 
      group, as it has been already shown by others. The novel finding of our work was 
      that AEs, including cancers, were less frequent in the T2T group with the 
      corresponding HRs being less than 0.50 for serious AEs, infections and serious 
      infections (significant or marginally non-significant results). There were 15 new 
      cancer cases in usual care and 1 in T2T group (IR 1.99 vs. 0.4, p=0.027). 
      CONCLUSIONS: Treat-to-target treatment with bDMARDs offers a safer, rapid and 
      better long-term outcome to patients with RA.
FAU - Lampropoulos, Christos E
AU  - Lampropoulos CE
AD  - Department of Pathophysiology, Medical School, National and Kapodistrian 
      University of Athens, Greece.
FAU - Orfanos, Philippos
AU  - Orfanos P
AD  - Department of Hygiene, Epidemiology and Medical Statistics, Medical School, 
      National and Kapodistrian University of Athens, Greece.
FAU - Manoussakis, Menelaos N
AU  - Manoussakis MN
AD  - Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical 
      School, National and Kapodistrian University of Athens, Greece.
FAU - Tzioufas, Athanasios G
AU  - Tzioufas AG
AD  - Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical 
      School, National and Kapodistrian University of Athens, Greece.
FAU - Moutsopoulos, Haralampos M
AU  - Moutsopoulos HM
AD  - Department of Pathophysiology, Medical School, National and Kapodistrian 
      University of Athens, Greece.
FAU - Vlachoyiannopoulos, Panayiotis G
AU  - Vlachoyiannopoulos PG
AD  - Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical 
      School, National and Kapodistrian University of Athens, Greece. pvlah@med.uoa.gr.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20170116
PL  - Italy
TA  - Clin Exp Rheumatol
JT  - Clinical and experimental rheumatology
JID - 8308521
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antirheumatic Agents/*administration & dosage/adverse effects
MH  - Arthritis, Rheumatoid/diagnosis/*drug therapy
MH  - Biological Products/*administration & dosage/adverse effects
MH  - Chi-Square Distribution
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Remission Induction
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - *Time-to-Treatment
MH  - Treatment Outcome
EDAT- 2017/01/18 06:00
MHDA- 2017/06/14 06:00
CRDT- 2017/01/18 06:00
PHST- 2016/01/11 00:00 [received]
PHST- 2016/05/02 00:00 [accepted]
PHST- 2017/01/18 06:00 [pubmed]
PHST- 2017/06/14 06:00 [medline]
PHST- 2017/01/18 06:00 [entrez]
AID - 10302 [pii]
PST - ppublish
SO  - Clin Exp Rheumatol. 2017 Mar-Apr;35(2):192-200. Epub 2017 Jan 16.