title: Determining the acceptable level of physician compliance with a treat-to-target strategy in early rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the minimum cut-points for rate of physician compliance with a treat-to-target (T2T) strategy needed to achieve optimal rates of remission or low disease activity (LDA).
  
  
  METHODS
  In this analysis of longitudinal observational data from patients with early RA, physician compliance with a T2T treatment protocol was determined for each clinic visit over 3 years. Remission and LDA were measured by Disease Activity Score in 28 joints (DAS28), simplified disease activity index (SDAI) and clinical disease activity index (CDAI). The minimum physician compliance rates for predicting these outcomes were calculated using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  Overall, 149 patients completed 3078 clinic visits over 3 years of follow-up. Treatment decisions complied with the T2T protocol in 2343 of these visits (76.1%). The minimum cut-points for physician compliance rates that predicted remission and LDA according to DAS28 were 81.1% and 70.7%, respectively, and to predict remission and LDA according to SDAI, the respective cut-points were 92.7% and 77.4%. Based on these cut-points, three categories of physician compliance with T2T were proposed: high (to maximize the likelihood of achieving remission, > 80% according to DAS28 or > 90% according to SDAI/CDAI); medium (the minimal physician compliance to achieve LDA, 70-79% according to DAS28 or 75-89% for SDAI/CDAI); and low (< 70% for DAS28 and < 75% for SDAI/CDAI), where remission and LDA are unlikely). When patients were stratified by baseline disease activity, the physician compliance rate cut-points were similar for most outcomes at year 3.
  
  
  CONCLUSIONS
  Using real-life clinical data, we determined the thresholds for physician compliance with a T2T strategy that stratified patients according to their disease outcomes and proposed a system for classifying physician compliance as high, medium and low.
authors.affiliation: School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Nasir
authors.initials: N
authors.lastname: Wabe
authors.affiliation: School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.|School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sorich
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia, Australia.|Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Mihir D
authors.initials: MD
authors.lastname: Wechalekar
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Cleland
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Leah
authors.initials: L
authors.lastname: McWilliams
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Anita
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Llewellyn
authors.initials: L
authors.lastname: Spargo
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Metcalf
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Cindy
authors.initials: C
authors.lastname: Hall
authors.affiliation: Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Proudman
authors.affiliation: School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wiese
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019540:Area Under Curve; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D004185:Disability Evaluation; D005260:Female; D019983:Guideline Adherence / Q000145:classification / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000145:classification / Q000592:standards*; D012372:ROC Curve; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: ROC curve; cut-off value; physician compliance; rheumatoid arthritis; treat-to-target