The online version of this article (doi:10.1007/s10067-016-3405-8) contains supplementary material, which is available to authorized users.
BeSt-study: [NTR262, NTR 265 (Dutch trial registry)] IMPROVED-study: [ISRCTN Register number 11916566 and EudraCT number 2006 06186-16]
To compare rheumatologists’ adherence to treatment protocols for rheumatoid arthritis (RA) targeted at Disease Activity Score (DAS) ≤2.4 or <1.6. The BeSt-study enrolled 508 early RA (1987) patients targeted at DAS ≤2.4. The IMPROVED-study included 479 early RA (2010) and 122 undifferentiated arthritis patients targeted at DAS <1.6. We evaluated rheumatologists’ adherence to the protocols and assessed associated opinions and conditions during 5 years. Protocol adherence was higher in BeSt than in IMPROVED (86 and 70 %), with a greater decrease in IMPROVED (from 100 to 48 %) than in BeSt (100 to 72 %). In BeSt, 50 % of non-adherence was against treatment intensification/restart, compared to 63 % in IMPROVED and 50 vs. 37 % were against tapering/discontinuation. In both studies, non-adherence was associated with physicians’ disagreement with DAS or with next treatment step and if patient’s visual analogue scale (VAS) for general health was ≥20 mm higher than the physician’s VAS. In IMPROVED, also discrepancies between swelling, pain, erythrocyte sedimentation rate, and VASgh were associated with non-adherence. Adherence to DAS steered treatment protocols was high but decreased over 5 years, more in a DAS <1.6 steered protocol. Non-adherence was more likely if physicians disagreed with DAS or next treatment step. In the DAS <1.6 steered protocol, non-adherence was also associated with discrepancies between subjective and (semi)objective disease outcomes, and often against required treatment intensification. These results may indicate that adherence to DAS-steered protocols appears to depend in part on the height of the target and on how physicians perceive the DAS reflects RA activity.
Egsmose C, Lund B, Borg G, et al. (1995) Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year followup of a prospective double blind placebo controlled study. J Rheumatol 22:2208–2213 PubMed
van Hulst LT, Creemers MC, Fransen J, et al. (2010) How to improve DAS28 use in daily clinical practice?—a pilot study of a nurse-led intervention. Rheumatology (Oxford) 49:741–748 CrossRef
Markusse IM, Dirven L, Han KH, et al. (2016) Evaluating adherence to a treat-to-target protocol in recent-onset rheumatoid arthritis: reasons for compliance and hesitation. Arthritis Care Res (Hoboken ) 68:446–453 CrossRef
Wolfe F, Michaud K, Pincus T, et al. (2005) The disease activity score is not suitable as the sole criterion for initiation and evaluation of anti-tumor necrosis factor therapy in the clinic: discordance between assessment measures and limitations in questionnaire use for regulatory purposes. Arthritis Rheum 52:3873–3879 CrossRefPubMed
den Uyl D, ter Wee M, Boers M, et al. (2014) A non-inferiority trial of an attenuated combination strategy (’COBRA-light’) compared to the original COBRA strategy: clinical results after 26 weeks. Ann Rheum Dis 73:1071–1078
Million L, Anderson J, Breneman J, et al. (2011) Influence of noncompliance with radiation therapy protocol guidelines and operative bed recurrences for children with rhabdomyosarcoma and microscopic residual disease: a report from the Children’s Oncology Group. Int J Radiat Oncol Biol Phys 80:333–338 CrossRefPubMed
- Rheumatologists’ adherence to a disease activity score steered treatment protocol in early arthritis patients is less if the target is remission
- Springer London
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II