Barriers to, Facilitators of, and Interventions to Support Treat-to-Target Implementation in Rheumatoid Arthritis: A Systematic Review

Arthritis Care Res (Hoboken). 2024 Dec;76(12):1626-1636. doi: 10.1002/acr.25408. Epub 2024 Sep 4.

Abstract

Objective: Treat-to-target is recommended in the management of rheumatoid arthritis (RA) but its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving treat-to-target implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support treat-to-target implementation.

Methods: Systematic and scoping literature searches in PubMed/MEDLINE, BIOSIS Previews, Derwent Drug File, Embase, EMCare, International Pharmaceutical Abstracts, and SciSearch were conducted to identify barriers/facilitators and interventions relating to treat-to-target implementation in RA. The quality of included studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Data related to barriers/facilitators and interventions were extracted, grouped, and summarized descriptively, and a narrative synthesis was generated.

Results: In total, 146 articles were analyzed, of which 123 (84%) included ≥50% of the items assessed by CASP checklists. Of the 146 studies, 76 evaluated treat-to-target barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including health care professional (HCP) or patient knowledge or perceptions; patient-HCP communication or alignment; and time or resources. Overall, 56 interventions were identified from 70 studies across the 18 target areas; 54% addressed disease activity or patient-reported outcome assessments. Of the 56 interventions identified, 36 improved treat-to-target implementation and/or patient outcomes in RA.

Conclusion: Despite long-established treat-to-target recommendations, there remain many barriers to its implementation. Interventions to improve treat-to-target should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and health care settings.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid* / drug therapy
  • Arthritis, Rheumatoid* / therapy
  • Humans
  • Treatment Outcome

Substances

  • Antirheumatic Agents

Grants and funding