title: Treat-to-target biologic therapy in patients with rheumatoid arthritis is more efficacious and safe compared to delayed initiation of biologics: a real-world study.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) is a chronic, devastating disease. Treat-to-target strategy (T2T) more than the usual care, reduces disease activity by using aggressively all therapeutic options. The aim of the study was to evaluate our hypothesis that T2T strategy using biologic disease-modifying anti-rheumatic drugs (bDMARDs), when needed, is also safer than the usual care characterised by delayed initiation of bDMARDs.
  
  
  METHODS
  Disease activity was regularly measured by DAS-28 until the end of treatment with the first bDMARD. All adverse events (AEs) and their severity were recorded. Cox proportional-hazards models were performed examining the association of treatment groups, with the risk of first AE.
  
  
  RESULTS
  There were 113 patients in T2T and 250 patients in usual care group. The likelihood (adjusted hazard ratio, HR) of achieving remission or LDA was 71% higher in the T2T group than in the usual care group, as it has been already shown by others. The novel finding of our work was that AEs, including cancers, were less frequent in the T2T group with the corresponding HRs being less than 0.50 for serious AEs, infections and serious infections (significant or marginally non-significant results). There were 15 new cancer cases in usual care and 1 in T2T group (IR 1.99 vs. 0.4, p=0.027).
  
  
  CONCLUSIONS
  Treat-to-target treatment with bDMARDs offers a safer, rapid and better long-term outcome to patients with RA.
authors.affiliation: Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Christos E
authors.initials: CE
authors.lastname: Lampropoulos
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Philippos
authors.initials: P
authors.lastname: Orfanos
authors.affiliation: Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Menelaos N
authors.initials: MN
authors.lastname: Manoussakis
authors.affiliation: Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Tzioufas
authors.affiliation: Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece.
authors.forename: Haralampos M
authors.initials: HM
authors.lastname: Moutsopoulos
authors.affiliation: Department of Pathophysiology, and Academic Joint Rheumatology Programme, Medical School, National and Kapodistrian University of Athens, Greece. pvlah@med.uoa.gr.
authors.forename: Panayiotis G
authors.initials: PG
authors.lastname: Vlachoyiannopoulos
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products