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Ferreira MF, Kohem CL, Xavier RM, Abegg E, Martins OS, Resmini MB, de Mello AL, de Almeida Menegat F, Hax V, Gasparin AA, Brenol CV, de Andrade NPB, Viecceli D, Brenol JCT, Palominos PE. Treating psoriatic arthritis to target: discordance between physicians and patients' assessment, non-adherence, and restricted access to drugs precluded therapy escalation in a real-world cohort. Clin Rheumatol 2018; 38:961-968. [PMID: 30511296 DOI: 10.1007/s10067-018-4383-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
The treat-to-target strategy (T2T) was associated with better outcomes in psoriatic arthritis (PsA) compared to standard care in clinical trials. This study aimed to analyze factors precluding treatment optimization in a T2T strategy conducted in a real-world cohort of PsA patients. A retrospective cross-sectional study nested in a cohort was conducted. Medical records of patients ≥ 18 years old, fulfilling CASPAR criteria and with at least one visit in the PsA clinic, were reviewed. Demographic data, current medication, and minimal disease activity (MDA) criteria were recorded. Reasons for the non-escalation of therapy in patients who were not classified as MDA were reported as absolute and relative frequencies. In the 8-month period, 131 visits (corresponding to 74 patients) were conducted. The MDA criteria were available in 113 visits (86.3%) and patients were classified as MDA in 31.0% of the visits (N = 35/113). Although in 69.0% of the visits patients were not in MDA, (N = 78/113), therapy was adjusted in only 42.3% (N = 33/78). Reasons precluding treatment escalation in non-MDA subjects were physician's impression of remission (57.7%, N = 26), non-adherence to previous prescription (17.8%, N = 8), restricted access to drugs (17.8%, N = 8), adverse events (11.1%, N = 5), poor understanding of medication instructions (6.7%, N = 3), patient's refusal to escalate therapy (4.4%, N = 2), and recent change in therapy (2.2%, N = 1). Discordance between the physician's clinical evaluation and the MDA criteria, non-adherence to prescription, and poor access to drugs were the main factors precluding escalation of therapy in a T2T strategy in a real-world PsA cohort.
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Affiliation(s)
- Manoela Fantinel Ferreira
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil
| | - Charles Lubianca Kohem
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | - Ricardo Machado Xavier
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | - Everton Abegg
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | - Otavio Silveira Martins
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | - Marcus Barg Resmini
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil
| | - Ariele Lima de Mello
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | - Franciele de Almeida Menegat
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil
| | - Vanessa Hax
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil
| | - Andrese Aline Gasparin
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil
| | - Claiton Viegas Brenol
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | | | - Daniela Viecceli
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil
| | - João Carlos Tavares Brenol
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.,Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2400, Porto Alegre, CEP 90035-903, Brazil
| | - Penélope Esther Palominos
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, CEP 90035-903, Brazil.
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