Factors influencing the use of biologic therapy and adoption of treat-to-target recommendations in current European rheumatology practice.

Objective: The aim of this study was to identify factors that influence treatment adjustments and adoption of a treat-to-target (T2T) strategy in patients with rheumatoid arthritis (RA) in European practices.
Methods: Cross-sectional data were drawn from the Adelphi 2014 RA Disease Specific Programme. Treatment patterns and clinical characteristics were investigated in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) vs non-bDMARDs. For the T2T analysis, patients were subdivided into two subsets (RA diagnosis <2 or ≥2 years) and compared according to the approach used (no target = no T2T approach; pragmatic = target different from remission; and aspirational = target set as remission).
Results: Data from 2,536 patients were analyzed (mean age: 52.76 years and mean time since RA diagnosis: 6.05 years). Of the 1,438 patients eligible to receive bDMARDs, 55% did not receive them. Initiation of bDMARDs in a bDMARD-naïve patient was prompted by worsening of the disease. In the RA diagnosis <2 years subset, a T2T approach was not adopted in 58% of the patients, whereas 8% and 34% adopted a pragmatic and aspirational approach, respectively. In the RA diagnosis ≥2 years subset, 45%, 19%, and 36% of the patients adopted a no target, pragmatic, and aspirational approach, respectively. Physician satisfaction with RA control was lower in the RA diagnosis <2 years subset than in the RA diagnosis ≥2 years subset (65% vs 77% satisfied, respectively; P <0.0001).
Conclusion: This analysis shows that the use of bDMARDs remains suboptimal and that a T2T strategy is not universally adopted.
Competing Interests: Disclosure PCT has received fees from AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, Sandoz, Biogen, and UCB Pharma. RA has received fees from AbbVie, Bristol-Myers Squibb, Janssen, Lilly, Merck, Pfizer, Sandoz, Biogen, and UCB Pharma. JJGR has received fees from AbbVie, Biogen, Bristol-Myers Squibb, Hospira, Janssen, Merck, Pfizer, Regeneron, and UCB Pharma. RC has received fees from AbbVie, MSD, Pfizer, Roche, and UCB Pharma. PB has received fees from MSD, Pfizer, Reckitt Benckiser, and Roche. ES, RW, and JP are employees of Adelphi Real World and were contracted by Pfizer to provide data, input into design of data collection, and statistical support for the development of this study. This study was spon sored by Pfizer. Adelphi Real World was contracted by Pfizer to conduct the survey and provide data, input into design of data collection, and statistical support for the development of this study. Preliminary data from this study were presented as posters at the British Society for Rheumatology (BSR) Annual Meeting, April 26–28, 2016, Glasgow, Scotland, and at the Annual Scientific Meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP); November 6–11, 2015; San Francisco, CA, USA. The authors report no other conflicts of interest in this work.