Journal article
Treat-to-target: not as simple as it appears
Clinical and experimental rheumatology, v 30(4 Suppl 73), pp S10-S20
Jul 2012
PMID: 23072741
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Treat-to-target as a strategy for rheumatoid arthritis (RA) is now widely advocated based on strong evidence. Nonetheless, implementation of treat-to-target raises caveats, as is the case with all clinical care strategies. The target of remission or even low disease activity does not apply to all individual patients, some of whom are affected by concomitant fibromyalgia, other comorbidities, joint damage, and/or who simply prefer to maintain current status and avoid risks of more aggressive therapies. No single universal 'target' measure or index exists for all individual RA patients. An emphasis in most studies on radiographic progression, rather than physical function or mortality, as the most important outcome to document the value of treat-to-target may be inappropriate. Many reports imply that the only limitation to treating all RA patients with biological agents involves costs, ignoring effective results in most patients with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs) and adverse events associated with biological agents. Indeed, the best outcomes in reported RA clinical trials result from tight control with DMARDs, rather than from biological agents, as does better overall status of RA patients at this time compared to previous decades. Pharmacoeconomic reports may ignore that RA patients are older, less educated, and have more comorbidities than the general population, as well as critical differences in patient status according to the gross domestic product of different countries. While treating to a target of remission or low disease activity, including with biological agents, is appropriate for many patients, awareness of these concerns could improve implementation of treat-to-target for optimal care of all RA patients.
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Details
- Title
- Treat-to-target: not as simple as it appears
- Creators
- Theodore Pincus - Division of Rheumatology, New York University School of Medicine and NYU Hospital for Joint Diseases, New York, NY 1003, USA. tedpincus@gmail.comIsabel CastrejónMartin J BergmanYusuf Yazici
- Publication Details
- Clinical and experimental rheumatology, v 30(4 Suppl 73), pp S10-S20
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate)
- Web of Science ID
- WOS:000310828700004
- Scopus ID
- 2-s2.0-84870268614
- Other Identifier
- 991019168210504721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Rheumatology