Objectives To investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target. Methods RA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models. Results In total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52). Conclusion In daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.

中文翻译：

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靶向治疗真的对类风湿性关节炎有效吗？在日常实践中接受治疗的一组患者的纵向分析 (RA BIODAM)

目的 旨在调查在日常临床实践中遵循靶向治疗 (T2T) 策略是否会导致更多类风湿性关节炎 (RA) 患者达到缓解目标。方法 来自 10 个国家的 RA 患者开始/改变传统的合成或生物疾病缓解抗风湿药物，每 3 个月评估一次疾病活动，持续 2 年（RA BIODAM（联合 DAMage 的生物标志物）队列）。每次就诊决定患者是否根据 T2T 策略以 44 关节疾病活动评分 (DAS44) 缓解 (DAS44 <1.6) 为目标进行治疗。持续 T2T 定义为在≥2 次连续访视中遵循 T2T。主要结果是在随后的 3 个月访问中实现 DAS44 缓解。根据 28 关节疾病活动评分-红细胞沉降率 (DAS28-ESR)、临床疾病活动指数 (CDAI)、简化疾病活动指数 (SDAI) 和美国风湿病学会/欧洲抗风湿病联盟 (ACR/ EULAR) 布尔定义。在广义估计方程模型中测试了 T2T 和缓解之间的关联。结果 共纳入 571 名患者（平均 (SD) 年龄：56 (13) 岁，78% 为女性）的 4356 次就诊。在 59% 的访问中发现 T2T 的适当应用。T2T（与无 T2T 相比）在 3 个月后并未产生更高的 DAS44 缓解可能性（OR（95% CI）：1.03（0.92 至 1.16）），但持续 T2T 导致实现 DAS44 缓解的可能性增加（OR：1.19 （1.03 到 1.39））。DAS28-ESR 缓解也观察到了类似的结果。对于更严格的定义（CDAI、SDAI 和 ACR/EULAR 布尔缓解），T2T 始终与缓解呈正相关（OR 范围：1.16 至 1.29），而持续 T2T 对缓解的影响更为明显（OR 范围：1.49 至 1.52） . 结论在日常临床实践中，RA患者正确应用T2T策略（尤其是持续T2T）可提高缓解率。