Treat-to-Target Approach in RA Found “Suboptimal”

Although treat-to-target (T2T) is a recommended strategy for the treatment of rheumatoid arthritis (RA), investigators writing in Arthritis Care & Research noted that “its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving T2T implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support T2T implementation.”

Systematic and scoping literature searches identified 146 studies that met quality criteria as assessed by the Critical Appraisal Skills Programme (CASP) checklists. The authors extracted, grouped, and summarized descriptively the data in these studies relating to barriers, facilitators, and interventions for T2T and generated a narrative synthesis.

“Of the 146 studies, 76 evaluated T2T barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including: healthcare professionals’ (HCPs’) or patients’ knowledge or perceptions; patient–HCP communication or alignment; and time or resources.”

The team identified 56 interventions from 70 studies across the 18 target areas, of which 54% addressed disease activity or patient-reported outcome assessments. Thirty-six of the interventions improved T2T implementation and/or patient outcomes in RA.

“Despite long-established T2T recommendations, there remain many barriers to its implementation,” the authors concluded. “Interventions to improve T2T should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and healthcare settings.”

Reference:

Gossec L, Bessette L, Xavier RM, Favalli EG, Östör A, Buch MH. Barriers to, facilitators of, and interventions to support treat-to-target implementation in rheumatoid arthritis: a systematic review. Arthritis Care Res. Published first August 1, 2024.