Patient–physician discordance impairs outcomes in early rheumatoid arthritis through less consistent treat-to-target implementation
Authors' conclusion
Even in a trial setting, T2T was applied on only around 50% of visits. T2T was less likely to be implemented with increasing patient-physician discordance regarding disease activity, which was in turn associated with less remission and worse functional outcome, but not with radiographic progression.
Study context
- Population
- Patients with early RA in the 2-year treat-to-target (T2T)-guided CareRA trial
- Participants
- 379 patients3,129 follow-up visits
- Comparison
- Association of time-varying patient-physician discordance score with T2T implementation and outcomes
- Primary endpoint
- Association between time-varying DS, T2T implementation and odds of remission (SDAI ≤3.3), physical functioning (HAQ) and radiographic progression
- Follow-up
- Year 2
Methodological detailsgeneralized linear mixed models, multilevel mediation analysis
- Generalized linear mixed models
- Multilevel mediation analysis
Primary result
As reported in the abstract
T2T implementation (DMARD escalation when DAS28-CRP >3.2) · over 2 years
Visits with DAS28-CRP >3.2
445
14%
DMARDs escalated when DAS28-CRP >3.2
217 of 445
49%
T2T implementation, year 1
57-66%
T2T implementation, year 2
17-52%
Original publication
Patient–physician discordance impairs outcomes in early rheumatoid arthritis through less consistent treat-to-target implementation. Rheumatology (Oxford). Published 21 December 2023. doi:10.
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