J Korean Med Sci.
2018 Dec;33(52):e346. 10.3346/jkms.2018.33.e346.
Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea
- Song JJ
- Song YW
- Bae SC
- Cha HS
- Choe JY
- Choi SJ
- Kim HA
- Kim J
- Kim SS
- Lee CK
- Lee J
- Lee SH
- Lee SS
- Lee SK
- Lee SW
- Park SH
- Park W
- Shim SC
- Suh CH
- Yoo B
- Yoo DH
- Yoo WH
- Affiliations
-
- 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ysong@snu.ac.kr
- 3Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea.
- 4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 5Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
- 6Department of Internal Medicine, Korea University Ansan Hospital, Korea University School of Medicine, Seoul, Korea.
- 7Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea.
- 8Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
- 9Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
- 10Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
- 11Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
- 12Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
- 13Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea.
- 14Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
- 15Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea.
- 16Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
- 17Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
- 18Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea.
- 19Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 20Department of Internal Medicine, Chonbuk National University, Medical School, Jeonju, Korea.
- KMID: 2429601
- DOI: http://doi.org/10.3346/jkms.2018.33.e346
Abstract
- BACKGROUND
To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea.
METHODS
In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) (2.6 ≤ DAS28 < 3.2).
RESULTS
Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (−0.38 vs. −0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001).
CONCLUSION
In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.
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