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Adverse Events and Resource Use Before and After Treat to Target in Rheumatoid Arthritis:A Post-Hoc Analysis of a Randomized Controlled Trial

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Solomon DH1, Yu Z1, Katz JN1,2, Bitton A3, Corrigan C1, Fraenkel L4, Harrold LR5, Smolen JS6, Losina E2, Lu B1. Arthritis Care Res (Hoboken). 2018 Sep 17. doi: 10.1002/acr.23755. [Epub ahead of print]

Abstract

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1 Division of Rheumatology.

2 Department of Orthopaedic Surgery.

3 Division of General Internal Medicine.

4 Brigham and Women's Hospital, Division of Rheumatology, Yale School of Medicine.

5 Division of Rheumatology, University of Massachusetts Medical Center.

6 Department of Rheumatology, University of Vienna.

Abstract

INTRODUCTION: Treat to target (TTT) is an accepted paradigm for care of patients with rheumatoid arthritis (RA). Since TTT can be associated with more medication switches, concerns arise whether implementing TTT may increase adverse events and/or resource use.

METHODS: We used data from six practices enrolled in an 18-month cluster-randomized controlled trial to compare adverse events and resource use before (months 1-9) and during (months 10-18) a TTT intervention. The outcomes of interest, adverse events and resource use, were based on medical record review of all rheumatology visits for RA patients before and during the intervention.

RESULTS: We examined records for 321 patients before the intervention and 315 during the intervention. An adverse event was recorded in 10.2% of visits before the intervention and 8.8% during the intervention (P = 0.41). Biologic DMARDs were used in 53.6% of patients before the intervention and 49.8% during the intervention (p = 0.73). Rheumatology visits were more frequent before the intervention (mean 4.0 ± 1.4) than during the intervention (mean 3.6 ± 1.2; p = 0.02). More visits were accompanied by monitoring laboratory tests before the intervention (90.0%) compared with during the intervention (52.7%; p <0.001). A greater percentage of visits before the intervention included diagnostic imaging (15.4%) versus during the intervention (8.9%; p<0.001).

CONCLUSIONS: We observed similar rates of adverse events before and during the implementation of TTT for RA. Rheumatology visits, use of laboratory monitoring, and diagnostic imaging did not increase during the TTT intervention.