title: Evaluating Adherence to a Treat-to-Target Protocol in Recent-Onset Rheumatoid Arthritis: Reasons for Compliance and Hesitation.
abstract: OBJECTIVE
  To evaluate rheumatologists' adherence to a low Disease Activity Score (DAS)-steered treat-to-target (T2T) strategy in treatment of patients with rheumatoid arthritis (RA) and to assess associated conditions.
  
  
  METHODS
  Data of the BeSt study were used, a multicenter T2T strategy trial with 10-year followup. During 3 monthly visits, the physician answered questions about satisfaction with level of RA suppression, agreement with the study protocol, and agreement with the DAS. Associations between the answers and nonadherence were evaluated.
  
  
  RESULTS
  Protocol adherence decreased over time from 100% to 60% per visit, with an average over time of 79%. Rheumatologists mostly agreed with the DAS (80-90% of visits over time) and were satisfied with the treatment steps (75-90%) and with the level of RA suppression (85-90%). The odds for protocol violation were higher when the rheumatologist disagreed with the DAS (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 2.0-2.7 when they thought the DAS overestimated actual disease activity; OR 2.5, 95% CI 2.0-3.1 when they thought the DAS underestimated actual disease activity) or with the next required treatment step (OR 3.0, 95% CI 2.5-3.5), and when the physician was dissatisfied with disease suppression (OR 1.3, 95% CI 1.1-1.6).
  
  
  CONCLUSIONS
  Rheumatologists generally agreed with and followed a 10-year followup DAS-steered T2T strategy. Disagreement with the DAS or the required treatment and dissatisfaction with the level of disease suppression were risk factors for nonadherence. These results indicate the feasibility of continued protocol-driven T2T therapy. For daily practice, adherence to T2T therapy might be improved by adopting the structure components of a clinical trial.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Markusse
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Dirven
authors.affiliation: Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: K H
authors.initials: KH
authors.lastname: Han
authors.affiliation: Haga Hospital, The Hague, The Netherlands.
authors.forename: H K
authors.initials: HK
authors.lastname: Ronday
authors.affiliation: Admiraal de Ruyter Hospital, Goes, The Netherlands.
authors.forename: P B J
authors.initials: PB
authors.lastname: de Sonnaville
authors.affiliation: Reade Hospital, Amsterdam, The Netherlands.
authors.forename: P J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.affiliation: Reade Hospital and VU Medical Center, Amsterdam, The Netherlands.
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: T W J
authors.initials: TW
authors.lastname: Huizinga
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D005240:Feasibility Studies; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009426:Netherlands; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents