Barriers Limit Treat-to-Target Efforts in Rheumatoid Arthritis

Patient preference and an elevated disease activity measure absent of rheumatoid arthritis (RA) activity are the two leading barriers to implementation of a treat-to-target strategy in RA, according to findings from a secondary analysis.

Adherence to a treat-to-target strategy is a recommended model for RA. However, research indicates various barriers to implementation.

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The researchers conducted a chart review using clinical visit records of 74 patients and assessed treat-to-target implementation based on whether there was designated a treatment target, recorded disease activity measure, shared-decision making when applicable, and adjusted treatment when disease activity was not at target.

Treat-to-target treatment standards were considered unfulfilled if treatment adjustment was absent when disease activity was not at the predetermined treatment target.

Among the analyzed visits, 83 were not in agreement with the treat-to-target strategy. Providers reported 90 barriers to treatment change among the evaluated visits.

Barriers to treatment adjustment included patient preference (37.1%) and elevated disease activity measure despite no equitable evidence of active RA (38.6%).

“Understanding barriers to adherence should guide interventions aimed at using better markers of disease activity and improving alignment with patient preference, with the overarching goal of enhancing TTT adherence,” the researchers concluded.

—Colleen Murphy

Reference:

Zak A, Corrigan C, Yu Z, et al. Barriers to treatment adjustment within a treat to target strategy in rheumatoid arthritis: a secondary analysis of the TRACTION trial. Rheumatology. 2018; 57(11):1933-1937. https://doi.org/10.1093/rheumatology/key179.