Treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis

Journal article


Hock, Emma Stefania, Martyn-St James, Marrissa, Wailoo, Allan, Scott, David L., Stevenson, Matt, Rawdin, Andrew, Simpson, Emma L., Dracup, Naila and Young, Adam 2021. Treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis. SN Comprehensive Clinical Medicine. 3 (3), pp. 838-854. https://doi.org/10.1007/s42399-021-00727-4
AuthorsHock, Emma Stefania, Martyn-St James, Marrissa, Wailoo, Allan, Scott, David L., Stevenson, Matt, Rawdin, Andrew, Simpson, Emma L., Dracup, Naila and Young, Adam
Abstract

To systematically review clinical and health economic impacts of treat-to-target (TTT) strategies in patients with rheumatoid arthritis (RA) managed in specialist units, compared with routine care. Sixteen and seven electronic databases were searched for clinical RCTs and cost-effectiveness respectively. Study selection, data extraction and quality assessment (Cochrane Collaboration risk of bias criteria) were performed. Evidence was reported by (1) TTT vs. usual care; (2) comparison of different treatment protocols against each other; (3) comparison of different targets against each other. Narrative synthesis was undertaken and conclusions drawn on a trial by trial basis, due to study heterogeneity. Twenty-two RCTs were included. Sixteen were at high risk of bias, five unclear and one low risk. Three trials showed TTT to be more effective than usual care in terms of remissions, in some or all comparisons, whereas one other trial reported no significant difference. Two trials showed TTT to be more effective than usual care in terms of low disease activity (LDA), in some or all comparisons, whereas two trials reported little difference. Some evidence suggests that TTT strategies involving combination therapy can achieve more remissions than those involving monotherapy, but little impact of alternative treatment targets on remission or LDA. Overall, there is evidence that TTT increases remissions in early RA and mixed early and established RA populations, and increases LDA in established RA. Although results varied, typically TTT was estimated to be more cost-effective than usual care. No target appears more effective than others.

KeywordsRheumatoid arthritis; Treat-to-target; Tight control
Year2021
JournalSN Comprehensive Clinical Medicine
Journal citation3 (3), pp. 838-854
PublisherSpringer Science and Business Media LLC
ISSN2523-8973
Digital Object Identifier (DOI)https://doi.org/10.1007/s42399-021-00727-4
Web address (URL)http://hdl.handle.net/10545/625674
https://creativecommons.org/licenses/by/4.0
hdl:10545/625674
Publication dates25 Jan 2021
Publication process dates
Deposited29 Mar 2021, 09:06
Accepted01 Jan 2021
ContributorsUniversity of Sheffield, King’s College Hospital NHS Foundation Trust, London, University of Derby and University of Hertfordshire
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https://repository.derby.ac.uk/item/9316v/treat-to-target-strategies-in-rheumatoid-arthritis-a-systematic-review-and-cost-effectiveness-analysis

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