title: Assessment of the treat-to-target strategy in patients with refractory rheumatoid arthritis. A prospective study on efficacy and safety in a Saudi population.
abstract: OBJECTIVE
  The goal of the present study was to prospectively assess the long-term clinical outcome of biologic modifying drug therapy in a population of Saudi rheumatoid arthritis (RA) patients.
  
  
  METHODS
  This is the first prospective, long-term report on the efficacy and safety of biologic therapy in Saudi RA patients. It is a single center, observational study with a follow-up period of 3 years. Enrolled were 120 biologic naïve patients (94 women, 78.3 %; mean age 48.4 ± 17.9 years, mean disease duration 7.3 ± 3.9 years) with the diagnosis of RA (ACR/EULAR, 2010 criteria) who were inadequate responders to methotrexate and synthetic DMARDs.
  
  
  RESULTS
  After 3 years, the mean Disease Activity Index-28 (DAS-28), Health Assessment Questionnaire (HAQ), Pain Score, ESR, and CRP values improved significantly. Of the 99 patients completing the 3-year follow-up, 35.3 % of patients achieved DAS-28 remission and 53.5 % achieved low disease activity, and 11.1 % of patients had moderate to high activity scores. At the 3-year follow-up, 80 % of patients had no evidence of significant radiographic progression (achieved < 0.5 of the mean total Sharp score). Infections were reported in 11.7 % and significantly correlated with conjugate use of oral prednisolone at doses above 5 mg/day, with chest infections being the most common type of infection (6.7 %).
  
  
  CONCLUSIONS
  The results of this study can be understood as real-life clinical experience displaying the incremental benefit of biologic therapy in refractory disease when it is added to other optimal strategies. The study showed satisfying clinical and functional benefit with considerable safety.
authors.affiliation: Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt, rmhamdy@yahoo.com.
authors.forename: R H A
authors.initials: RH
authors.lastname: Mohammed
authors.forename: H H
authors.initials: HH
authors.lastname: Kewan
authors.forename: M
authors.initials: M
authors.lastname: Bukhari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage*; D002908:Chronic Disease; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D011446:Prospective Studies; D012529:Saudi Arabia; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products; D008727:Methotrexate