Reviewing Treatment Trends and Effectiveness of Medication for Patients with Rheumatoid Arthritis Throughout 15 Years Under the Treat-to-Target Strategy in Real-World Practice in Japan

Objectives: The evidence for treating rheumatoid arthritis (RA) with a treat-to-target (T2T) approach was examined for clinical outcomes. Methods: Since August 2010, RA treatment has implemented the T2T strategy, aiming to achieve a simplified disease activity index (SDAI). The SDAI, Health Assessment Questionnaire Disability Index (HAQ), and pain score (PS-VAS) were monitored. The relationships between these clinical outcomes and variables, including changes in medication, were investigated. Results: Over a 15-year follow-up of 764 RA patients, the total duration was divided into two periods for each outcome. In the First period, the average dose of methotrexate (MTX) increased (p < 0.001). At the same time, glucocorticoids use (GCs) decreased (p < 0.001), and biologic and targeted synthetic disease-modifying anti-rheumatic drugs (bDMARDs and tsDMARDs) use increased (p < 0.01). Consequently, the mean SDAI score declined (p < 0.001), which was attributed to an increase in MTX dose and a decrease in GCs use, However, HAQ scores increased (p < 0.01), and PS-VAS remain stable. In the Second period, the average MTX dose decreased despite stable SDAI and decreasing HAQ scores and PS-VAS (p < 0.01), which was attributed to an increase in the use of tsDMARDs, particularly baricitinib, upadacitinib, and filgotinib (p < 0.01). Overall, the average age increased (p < 0.001), while SDAI scores dropped (p < 0.001), and HAQ scores and PS-VAS decreased (p < 0.01). Conclusions: Clinical outcomes stayed stable with changes in medication use under the T2T approach.