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Adherence of Italian rheumatologists to the EULAR recommendations and outcomes in early rheumatoid arthritis patients after starting conventional DMARDs: Methotrexate in Italian patients wiTh Rheumatoid Arthritis (the MITRA study). A cohort study of the I


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16

 

  1. Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy.
  2. Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
  3. Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
  4. Rheumatology, Central Hospital of Bolzano, Italy.
  5. Rheumatology Unit, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
  6. Rheumatology Unit, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
  7. Rheumatology Unit, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy.
  8. Rheumatology Unit, Mauriziano Hospital, Turin, Italy.
  9. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.
  10. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.
  11. Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, and Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
  12. Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, and Rheumatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
  13. Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy.
  14. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria di Ferrara, Cona, and Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy.
  15. Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, and Department of Clinical Sciences and Community Health, Research Center for Adult and Paediatric Rheumatic Diseases, Università degli Studi di Milano, Italy.
  16. Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy. florenzo.iannone@uniba.it

CER15009
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PMID: 35084309 [PubMed]

Received: 18/07/2021
Accepted : 18/10/2021
In Press: 12/01/2022

Abstract

OBJECTIVES:
The aim of this study was to assess the real-life adherence of Italian rheumatologist to the 2013 EULAR recommendations and treatment outcome in rheumatoid arthritis (RA) patients who started a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD).
METHODS:
The MITRA study is an Italian multicentre observational cohort focused on treatment naïve RA patients with early diagnosis recruited in an 18-month period starting from 2015. The data related to treatment with csDMARDs during the following 12 months follow-up were presented in this paper.
RESULTS:
Two-hundred and fifty-nine RA patients from MITRA cohort who had a follow-up visit and started a csDMARD were included in the prospective analysis. Methotrexate was started as first conventional DMARD in 224 (86.4%) patients. During the first year after starting conventional DMARDs, 175 (67.6%) RA patients reached the pre-specified target, which was DAS28 remission (<2.6) for 112 (43.2%) patients and LDA (<3.2) for 63 (24.3%) patients. Factors that negatively impacted the target achievement were fibromyalgia (HR: 0.2 [0.05–0.81]), HAQ-DI (HR: 0.72 [0.56–0.93]) and ESR (HR: 0.99 [0.99–1]). Globally, 33 (12.7%) patients started a biologic DMARD, while 61 out of 84 (72.6%) patients who had never reached the target remained on conventional DMARD. One-hundred and ninety-three adverse events (AEs) were recorded, the majority classified as mild (91 cases, 51%).
CONCLUSIONS:
A high proportion of RA patients achieved the target during the first-year follow-up. However, a considerable portion of RA patients did not start a biological drug although the target was never reached. AEs remain frequent with conventional DMARDs, but the majority were mild.

DOI: https://doi.org/10.55563/clinexprheumatol/77i56a

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