1 Taylor PC, et al. RMD Open 2022;8:e002658. doi:10.1136/rmdopen-2022-002658 ORIGINAL RESEARCH Treat-to-target in rheumatoid arthritis: a real-world study of the application and impact of treat-to-target within the wider context of patient management, patient centricity and advanced therapy use in Europe Peter C. Taylor , 1 Bruno Fautrel , 2,3 Yves Piette, 4 Susana Romero-Yuste, 5 Jasper Broen, 6 Martin Welcker, 7 Oliver Howell, 8 Elke Rottier, 8 Monia Zignani, 9 Katrien Van Beneden, 10 Roberto Caporali, 11,12 Rieke Alten 13 To cite: Taylor PC, Fautrel B, Piette Y, et al. Treat-to-target in rheumatoid arthritis: a real- world study of the application and impact of treat-to-target within the wider context of patient management, patient centricity and advanced therapy use in Europe. RMD Open 2022;8:e002658. doi:10.1136/ rmdopen-2022-002658 ► Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi.org/10. 1136/rmdopen-2022-002658). Received 10 August 2022 Accepted 8 November 2022 For numbered affiliations see end of article. Correspondence to Peter C. Taylor; peter.taylor@kennedy.ox.ac.uk Rheumatoid arthritis © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Background While treat-to-target (T2T) is endorsed for the management of rheumatoid arthritis (RA), data on the degree of implementation in clinical practice are limited. This study investigated the use of T2T for RA in a real-world setting across Europe. Methods The Adelphi RA Disease-Specific Programme was a point-in-time survey of rheumatologists and their consulting patients with RA conducted between January and October 2020 in Belgium, France, Germany, Italy, Spain and the UK. Rheumatologists completed an attitudinal survey, and a record form for their next 10–12 consulting patients, who were invited to voluntarily complete a patient-reported questionnaire. Data collected included clinical characteristics, treatment patterns and attitudes towards T2T. Results Overall, 316 rheumatologists provided data for 3120 patients, of whom 1108 completed the questionnaire. While 86.1% of rheumatologists estimated using T2T principles in clinical practice, only 66.6% of patients were reported by their physician to be managed using a T2T approach. Achieving disease remission was the most commonly reported treatment goal identified by rheumatologists (79.7%), followed by symptom control (47.8%) and reducing impact on quality of life (44.5%). 40.8% of rheumatologists and their patients were in agreement that a treatment goal had been set. When there was agreement on treatment goals, we observed better patient satisfaction, engagement and treatment success. Conclusions Despite recommendations, the T2T approach in RA appears to be suboptimally implemented in clinical practice. This highlights the importance of patient-centricity in the decision-making process to define meaningful targets and select appropriate treatments to improve disease outcomes. INTRODUCTION Rheumatoid arthritis (RA) is an autoimmune disease characterised by chronic inflam- mation and is associated with progressive cartilage damage and joint destruction. 1 2 RA remains without a cure and if left untreated, results in loss of physical function, reduced overall quality of life (QoL), disability and increased mortality. The main treatment goal is to achieve disease remission, or at least maintain a low level of disease activity as an WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ While treat-to-target (T2T) principles are endorsed for the management of rheumatoid arthritis (RA), there are limited data on the degree of implementa- tion in clinical practice. WHAT THIS STUDY ADDS ⇒ The results of this study indicate that while a major- ity of rheumatologists (86%) support T2T principles, only two-thirds of their patients with RA were man- aged using a T2T approach. ⇒ A minority of rheumatologists and their patients (41%) were in agreement that a T2T goal had been set. ⇒ Where there was agreement on a T2T goal between rheumatologist and patient, higher rates of patient satisfaction, engagement and treatment success result. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ There is a need to expand adoption of T2T strategies in the management of people living with RA in order to further optimise achievable quality of life goals. ⇒ These findings highlight the importance of shared decision-making that involves patients in defining meaningful targets and in selection of appropriate treatments to achieve them. on December 29, 2023 by guest. Protected by copyright. http://rmdopen.bmj.com/ RMD Open: first published as 10.1136/rmdopen-2022-002658 on 22 December 2022. Downloaded from