Incorporating the Treat-to-Target Concept in Rheumatoid Arthritis

AUTHORS: Eric M. Ruderman, Kamala M. Nola, Stanley Ferrell, Tamar Sapir, Davecia R. Cameron

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SUMMARY: BACKGROUND: Recent publications have proposed revisions to disease
classification criteria, new definitions of remission, and guidelines for
implementing treat-to-target strategies for the management of patients
with rheumatoid arthritis (RA). Despite developments leading to this
practice-changing approach, the concept of treat to target has not yet
been widely accepted or implemented in managed care. At the 24th Annual
Meeting & Expo of the Academy of Managed Care Pharmacy (AMCP), held
in San Francisco on April 18, 2012, a 4-hour activity titled Incorporating
New Treat-to-Target Guidance and Strategies in RA: What Managed Care
Needs to Know was conducted in association with AMCP’s Continuing
Professional Education Partner Program. The practicum featured didactic
presentations, a roundtable session, and an expert panel discussion detailing
research evidence, ideas, and discussion topics central to the treat-totarget
concept in RA and its applications to managed care.
OBJECTIVES: To (a) discuss recent advances in RA management, (b) evaluate
strategies to optimize the use of disease-modifying antirheumatic drugs
(DMARDs), and (c) explain how to incorporate the treat-to-target paradigm
in contemporary clinical practice and clinical care models in order to
improve outcomes for patients.
SUMMARY: The past decade has seen a tremendous amount of change in
the field of rheumatology. The early and aggressive treatment of RA, including
the use of novel biologic agents, has been shown to have favorable
patient outcomes in reducing synovial inflammation, delaying joint damage,
and maintaining functional status, leading to the recently published
revisions in classification criteria and updated recommendations for the
utilization of conventional DMARDs and biologic agents in the treatment of
RA. The revised classification criteria can be used to diagnose RA patients
at an earlier point in the disease course by placing greater emphasis on
clinical features that manifest early in the disease process. The concept
of achieving tight control of RA and treating to target has been well established
and utilizes early diagnosis, aggressive treatment, and regular monitoring,
leading to positive outcomes in a significant number of patients with
RA who achieve current treatment goals of low levels of disease activity or
clinical remission.

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