Rheuma Treat To Target
Erstellt am 29 Jul 2018 12:28
Zuletzt geändert: 14 Oct 2018 11:16
2018
- Bergstra SA, Allaart CF. What is the optimal target for treat-to-target strategies in rheumatoid arthritis? Curr Opin Rheumatol. 2018 Jan 19. doi: 10.1097/BOR.0000000000000484. [Epub ahead of print] Autoren: Universität Leiden.
- SUMMARY:
- There were no benefits of aiming for ultrasound remission in RA-patients. To decide whether remission or LDA is the best target in the treatment of RA-patients, a randomized clinical trial comparing both targets would be needed. On an individual level, cotargets such as functional ability should be considered.
- Kavanaugh A, van Vollenhoven RF, Fleischmann R, et al. Testing treat-to-target outcomes with initial methotrexate monotherapy compared with initial tumour necrosis factor inhibitor (adalimumab) plus methotrexate in early rheumatoid arthritis. Ann Rheum Dis. 2018 Feb;77(2):289-292. doi: 10.1136/annrheumdis-2017-211871. Epub 2017 Nov 16. (Volltext).
- Conclusions:
- In early RA, starting with MTX monotherapy and adding TNFi after 26 weeks yields similar longer term clinical results as starting with TNFi+MTX combination therapy but allows a small but significant accrual of radiographic damage.
- Kneitz C, Fiehn C. In-label-Therapie entzündlicher Gelenkerkrankungen. Z Rheumatol. 2018 Jul 2.
- Larmore CJ, Boytsov NN, Gaich CL, Zhang X, Araujo AB, Rebello S, Salim BA, Reed GW, Harrold LR. Examination of Patient-Reported Outcomes in Association with TNF-Inhibitor Treatment Response: Results from a US Observational Cohort Study. Rheumatol Ther. 2018 Jan 10. doi: 10.1007/s40744-017-0092-0. [Epub ahead of print] Autoren: Pharma! (Eli Lilly, Corona, Axio Research)
- CONCLUSION:
- Reduction in disease activity was associated with improvements in PROs, with the greatest improvements seen in those who achieved sustained remission/LDA. These results reinforce the benefits of a treat-to-target approach to RA care and may improve dialogue between patients and providers, support shared decision-making, and reduce "clinical inertia."
2017
- Aletaha D, Snedecor SJ, Ektare V, et al. Clinical and economic analysis of outcomes of dose tapering or withdrawal of tumor necrosis factor-α inhibitors upon achieving stable disease activity in rheumatoid arthritis patients. Clinicoecon Outcomes Res. 2017 Jul 28;9:451-458. (Volltext).
- Conclusion:
- Dose tapering or withdrawal of anti-TNFs results in similar reduction of health care costs but less time in sustained disease control compared to maintaining therapy. Future research is needed to understand the long-term clinical consequences of these strategies and patient preferences for treatment withdrawal.
- Ein Autor arbeitet bei AbbVie Inc., North Chicago, IL, USA.
- Solomon DH, Losina E, Lu B, Zak A, Corrigan C, Lee SB, Agosti J, Bitton A, Harrold LR, Pincus T, Radner H, Yu Z, Smolen JS, Fraenkel L, Katz JN.Implementation of Treat-to-Target in Rheumatoid Arthritis Through a Learning Collaborative: Results of a Randomized Controlled Trial. Arthritis Rheumatol. 2017 Jul;69(7):1374-1380. doi: 10.1002/art.40111. Autoren: Academia multinational.
- CONCLUSION:
- A learning collaborative resulted in substantial improvements in adherence to TTT for the management of RA. This study supports the use of an educational collaborative to improve quality.
- Wailoo A, Hock ES, Stevenson M, Martyn-St James M, Rawdin A, Simpson E, Wong R, Dracup N, Scott DL, Young A. The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2017 Nov;21(71):1-258. doi: 10.3310/hta21710. Autoren: Universität Sheffield und NHS.
- CONCLUSION:
- In early RA and studies of mixed early and established RA populations, evidence suggests that TTT improves remission rates. In established disease, TTT may lead to improved rates of LDA. It remains unclear which element(s) of TTT (the target, treatment protocols or increased frequency of patient visits) drive these outcomes. Future trials comparing TTT with usual care and/or different TTT targets should use outcomes comparable with existing literature. Remission, defined in a consistent manner, should be the target of choice of future studies.
2016
- Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun;76(6):960-977. (Volltext)
- In the presence of unfavourable prognostic markers (autoantibodies, high disease activity, early erosions, failure of 2 csDMARDs), any bDMARD (current practice) or Jak-inhibitor should be added to the csDMARD. If this fails, any other bDMARD or tsDMARD is recommended. If a patient is in sustained remission, bDMARDs can be tapered.
2010
- Smolen JS, Aletaha D, Bijlsma JW, et al. T2T Expert Committee. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010 Apr;69(4):631-7. (Volltext)
- RESULTS:
- The treat-to-target activity resulted in 10 recommendations. The treatment aim was defined as remission with low disease activity being an alternative goal in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with appropriate therapeutic adaptation to reach the desired state within 3 to a maximum of 6 months was recommended. Follow-up examinations ought to employ composite measures of disease activity which include joint counts. Additional items provide further details for particular aspects of the disease. Levels of agreement were very high for many of these recommendations (> or =9/10).
- CONCLUSION:
- The 10 recommendations are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA based on evidence and expert opinion.
Sonstiges - Weblinks
- Gezielt und frühzeitig therapieren, ist das Erfolgsrezept bei rheumatoider Arthritis – eine neue Leitlinie zeigt, wie’s geht
- Goldgräberstimmung in der Rheumatologie: Die Entwicklung zielgerichteter Substanzen boomt
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