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dc.contributor.authorHarrold, Leslie R.
dc.contributor.authorReed, George W.
dc.contributor.authorHarrington, J. Timothy
dc.contributor.authorBarr, Christine J.
dc.contributor.authorSaunders, Katherine C.
dc.contributor.authorGibofsky, Allan
dc.contributor.authorGreenberg, Jeffrey D.
dc.contributor.authorJohn, Ani
dc.contributor.authorDevenport, Jenny
dc.contributor.authorKremer, Joel M.
dc.date2022-08-11T08:08:32.000
dc.date.accessioned2022-08-23T15:58:10Z
dc.date.available2022-08-23T15:58:10Z
dc.date.issued2014-11-21
dc.date.submitted2015-05-29
dc.identifier.citationBMC Musculoskelet Disord. 2014 Nov 21;15:389. doi: 10.1186/1471-2474-15-389. <a href="http://dx.doi.org/10.1186/1471-2474-15-389">Link to article on publisher's site</a>
dc.identifier.issn1471-2474 (Linking)
dc.identifier.doi10.1186/1471-2474-15-389
dc.identifier.pmid25416400
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30372
dc.description.abstractBACKGROUND: The treat-to-target (T2T) approach to the care of patients with rheumatoid arthritis involves using validated metrics to measure disease activity, frequent follow-up visits for patients with moderate to high disease activity, and escalation of therapy when patients have inadequate therapeutic response as assessed by standard disease activity scores. The study described is a newly launched cluster-randomized behavioral intervention to assess the feasibility and effectiveness of the T2T approach in US rheumatology practices. It is designed to identify patient and provider barriers to implementing T2T management. This initial paper focuses on the novel study design and methods created to provide these insights. METHODS/DESIGN: This trial cluster-randomizes rheumatology practices from the existing Corrona network of private and academic sites rather than patients within sites or individual investigators to provide either T2T or usual care (UC) for qualified patients who meet the 2010 revised American College of Rheumatology criteria for the diagnosis of rheumatoid arthritis and have moderate to high disease activity. Specific medication choices are left to the investigator and patient, rather than being specified in the protocol. Enrollment is expected to be completed by the end of 2013, with 30 practices randomized and enrolling a minimum of 530 patients. During the 12-month follow-up, visits are mandated as frequently as monthly in patients with active disease in the T2T group and every 3 months for the UC group. Safety data are collected at each visit. The coprimary endpoints include a comparison of the proportion of patients achieving low disease activity in the T2T and UC groups and assessment of the feasibility of implementing T2T in rheumatology practices, specifically assessment of the rates of treatment acceleration, frequency of visits, time to next visit conditional on disease activity, and probability of acceleration conditional on disease activity in the 2 groups. DISCUSSION: This cluster-randomized behavioral intervention study will provide valuable insights on the outcomes and feasibility of employing a T2T treatment approach in clinical practice in the United States. TRIAL REGISTRATION: NCT01407419.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=25416400&dopt=Abstract">Link to Article in PubMed</a>
dc.rightsCopyright © Harrold et al.; licensee BioMed Central Ltd. 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<a href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<a href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</a>) applies to the data made available in this article, unless otherwise stated.
dc.subjectrheumatoid arthritis
dc.subjecttreat-to-target (T2T)
dc.subjectHealth Services Research
dc.subjectImmune System Diseases
dc.subjectMusculoskeletal Diseases
dc.subjectRheumatology
dc.titleThe rheumatoid arthritis treat-to-target trial: a cluster randomized trial within the Corrona rheumatology network
dc.typeJournal Article
dc.source.journaltitleBMC musculoskeletal disorders
dc.source.volume15
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1643&amp;context=faculty_pubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/644
dc.identifier.contextkey7158523
refterms.dateFOA2022-08-23T15:58:10Z
html.description.abstract<p>BACKGROUND: The treat-to-target (T2T) approach to the care of patients with rheumatoid arthritis involves using validated metrics to measure disease activity, frequent follow-up visits for patients with moderate to high disease activity, and escalation of therapy when patients have inadequate therapeutic response as assessed by standard disease activity scores. The study described is a newly launched cluster-randomized behavioral intervention to assess the feasibility and effectiveness of the T2T approach in US rheumatology practices. It is designed to identify patient and provider barriers to implementing T2T management. This initial paper focuses on the novel study design and methods created to provide these insights.</p> <p>METHODS/DESIGN: This trial cluster-randomizes rheumatology practices from the existing Corrona network of private and academic sites rather than patients within sites or individual investigators to provide either T2T or usual care (UC) for qualified patients who meet the 2010 revised American College of Rheumatology criteria for the diagnosis of rheumatoid arthritis and have moderate to high disease activity. Specific medication choices are left to the investigator and patient, rather than being specified in the protocol. Enrollment is expected to be completed by the end of 2013, with 30 practices randomized and enrolling a minimum of 530 patients. During the 12-month follow-up, visits are mandated as frequently as monthly in patients with active disease in the T2T group and every 3 months for the UC group. Safety data are collected at each visit. The coprimary endpoints include a comparison of the proportion of patients achieving low disease activity in the T2T and UC groups and assessment of the feasibility of implementing T2T in rheumatology practices, specifically assessment of the rates of treatment acceleration, frequency of visits, time to next visit conditional on disease activity, and probability of acceleration conditional on disease activity in the 2 groups.</p> <p>DISCUSSION: This cluster-randomized behavioral intervention study will provide valuable insights on the outcomes and feasibility of employing a T2T treatment approach in clinical practice in the United States.</p> <p>TRIAL REGISTRATION: NCT01407419.</p>
dc.identifier.submissionpathfaculty_pubs/644
dc.contributor.departmentDepartment of Orthopedics
dc.source.pages389


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