Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Treat-to-Target Strategy for Asian Patients with Early Rheumatoid Arthritis: Result of a Multicenter Trial in Korea

  • Song, Jason Jungsik (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Song, Yeong Wook (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Bae, Sang Cheol (Department of Internal Medicine, Hanyang University School of Medicine) ;
  • Cha, Hoon-Suk (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Jung-Yoon (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Choi, Sung Jae (Department of Internal Medicine, Korea University Ansan Hospital, Korea University School of Medicine) ;
  • Kim, Hyun Ah (Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine) ;
  • Kim, Jinseok (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Kim, Sung-Soo (Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Lee, Choong-Ki (Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Lee, Jisoo (Department of Internal Medicine, Ewha Womans University College of Medicine) ;
  • Lee, Sang-Heon (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Lee, Shin-Seok (Department of Internal Medicine, Chonnam National University Medical School and Hospital) ;
  • Lee, Soo-Kon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Sung Won (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, Sung-Hwan (Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine) ;
  • Park, Won (Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine) ;
  • Shim, Seung Cheol (Department of Internal Medicine, Chungnam National University College of Medicine) ;
  • Suh, Chang-Hee (Department of Rheumatology, Ajou University School of Medicine) ;
  • Yoo, Bin (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo, Dae-Hyun (Department of Internal Medicine, Hanyang University School of Medicine) ;
  • Yoo, Wan-Hee (Department of Internal Medicine, Chonbuk National University, Medical School)
  • Received : 2018.04.05
  • Accepted : 2018.07.18
  • Published : 2018.12.24
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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) ($2.6{\leq}DAS28$ < 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.

Keywords

Acknowledgement

Supported by : AbbVie Korea

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