Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis: Reasons for Compliance and Hesitation

I M Markusse, L Dirven, K H Han, H K Ronday, P B J de Sonnaville, P J S M Kerstens, W F Lems, T W J Huizinga, C F Allaart

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions.

METHODS: Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated.

RESULTS: Protocol adherence decreased over time from 100% to 60% per visit, with an average over time of 79%. Rheumatologists mostly agreed with the DAS (80-90% of visits over time) and were satisfied with the treatment steps (75-90%) and with the level of RA suppression (85-90%). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95% CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95% CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95% CI 1.1-1.6).

CONCLUSION: Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.

Original languageEnglish
Pages (from-to)446-53
Number of pages8
JournalArthritis Care & Research
Volume68
Issue number4
DOIs
Publication statusPublished - Apr 2016

Cite this

Markusse, I. M., Dirven, L., Han, K. H., Ronday, H. K., de Sonnaville, P. B. J., Kerstens, P. J. S. M., ... Allaart, C. F. (2016). Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis: Reasons for Compliance and Hesitation. Arthritis Care & Research, 68(4), 446-53. https://doi.org/10.1002/acr.22681
Markusse, I M ; Dirven, L ; Han, K H ; Ronday, H K ; de Sonnaville, P B J ; Kerstens, P J S M ; Lems, W F ; Huizinga, T W J ; Allaart, C F. / Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis : Reasons for Compliance and Hesitation. In: Arthritis Care & Research. 2016 ; Vol. 68, No. 4. pp. 446-53.
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title = "Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis: Reasons for Compliance and Hesitation",
abstract = "OBJECTIVE: To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions.METHODS: Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated.RESULTS: Protocol adherence decreased over time from 100{\%} to 60{\%} per visit, with an average over time of 79{\%}. Rheumatologists mostly agreed with the DAS (80-90{\%} of visits over time) and were satisfied with the treatment steps (75-90{\%}) and with the level of RA suppression (85-90{\%}). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95{\%} confidence interval [95{\%} CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95{\%} CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95{\%} CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95{\%} CI 1.1-1.6).CONCLUSION: Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.",
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author = "Markusse, {I M} and L Dirven and Han, {K H} and Ronday, {H K} and {de Sonnaville}, {P B J} and Kerstens, {P J S M} and Lems, {W F} and Huizinga, {T W J} and Allaart, {C F}",
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Markusse, IM, Dirven, L, Han, KH, Ronday, HK, de Sonnaville, PBJ, Kerstens, PJSM, Lems, WF, Huizinga, TWJ & Allaart, CF 2016, 'Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis: Reasons for Compliance and Hesitation' Arthritis Care & Research, vol. 68, no. 4, pp. 446-53. https://doi.org/10.1002/acr.22681

Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis : Reasons for Compliance and Hesitation. / Markusse, I M; Dirven, L; Han, K H; Ronday, H K; de Sonnaville, P B J; Kerstens, P J S M; Lems, W F; Huizinga, T W J; Allaart, C F.

In: Arthritis Care & Research, Vol. 68, No. 4, 04.2016, p. 446-53.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis

T2 - Reasons for Compliance and Hesitation

AU - Markusse, I M

AU - Dirven, L

AU - Han, K H

AU - Ronday, H K

AU - de Sonnaville, P B J

AU - Kerstens, P J S M

AU - Lems, W F

AU - Huizinga, T W J

AU - Allaart, C F

N1 - © 2016, American College of Rheumatology.

PY - 2016/4

Y1 - 2016/4

N2 - OBJECTIVE: To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions.METHODS: Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated.RESULTS: Protocol adherence decreased over time from 100% to 60% per visit, with an average over time of 79%. Rheumatologists mostly agreed with the DAS (80-90% of visits over time) and were satisfied with the treatment steps (75-90%) and with the level of RA suppression (85-90%). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95% CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95% CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95% CI 1.1-1.6).CONCLUSION: Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.

AB - OBJECTIVE: To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions.METHODS: Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated.RESULTS: Protocol adherence decreased over time from 100% to 60% per visit, with an average over time of 79%. Rheumatologists mostly agreed with the DAS (80-90% of visits over time) and were satisfied with the treatment steps (75-90%) and with the level of RA suppression (85-90%). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95% CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95% CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95% CI 1.1-1.6).CONCLUSION: Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.

KW - Antirheumatic Agents

KW - Arthritis, Rheumatoid

KW - Attitude of Health Personnel

KW - Feasibility Studies

KW - Guideline Adherence

KW - Health Knowledge, Attitudes, Practice

KW - Humans

KW - Netherlands

KW - Odds Ratio

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'

KW - Predictive Value of Tests

KW - Program Evaluation

KW - Severity of Illness Index

KW - Surveys and Questionnaires

KW - Time Factors

KW - Treatment Outcome

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1002/acr.22681

DO - 10.1002/acr.22681

M3 - Article

VL - 68

SP - 446

EP - 453

JO - Arthritis Care & Research

JF - Arthritis Care & Research

SN - 2151-464X

IS - 4

ER -