Incorporating the Treat-to-Target Concept in Rheumatoid Arthritis

BACKGROUND: Recent publications have proposed revisions to diseaseclassification criteria, new definitions of remission, and guidelines forimplementing treat-to-target strategies for the management of patientswith rheumatoid arthritis (RA). Despite developments leading to thispractice-changing approach, the concept of treat to target has not yetbeen widely accepted or implemented in managed care. At the 24th AnnualMeeting Expo of the Academy of Managed Care Pharmacy (AMCP), heldin San Francisco on April 18, 2012, a 4-hour activity titled IncorporatingNew Treat-to-Target Guidance and Strategies in RA: What Managed CareNeeds to Know was conducted in association with AMCP’s ContinuingProfessional Education Partner Program. The practicum featured didacticpresentations, a roundtable session, and an expert panel discussion detailingresearch evidence, ideas, and discussion topics central to the treat-totargetconcept in RA and its applications to managed care. OBJECTIVES: To (a) discuss recent advances in RA management, (b) evaluatestrategies to optimize the use of disease-modifying antirheumatic drugs(DMARDs), and (c) explain how to incorporate the treat-to-target paradigmin contemporary clinical practice and clinical care models in order toimprove outcomes for patients. SUMMARY: The past decade has seen a tremendous amount of change inthe field of rheumatology. The early and aggressive treatment of RA, includingthe use of novel biologic agents, has been shown to have favorablepatient outcomes in reducing synovial inflammation, delaying joint damage,and maintaining functional status, leading to the recently publishedrevisions in classification criteria and updated recommendations for theutilization of conventional DMARDs and biologic agents in the treatment ofRA. The revised classification criteria can be used to diagnose RA patientsat an earlier point in the disease course by placing greater emphasis onclinical features that manifest early in the disease process. The conceptof achieving tight control of RA and treating to target has been well establishedand utilizes early diagnosis, aggressive treatment, and regular monitoring,leading to positive outcomes in a significant number of patients withRA who achieve current treatment goals of low levels of disease activity orclinical remission.