Good-bye to a successful ACR 2014 in Boston.
Themes at this meeting were broad but what resonated with me were the following:
There is some ability to reduce dose or de-medicate patients with RA in deep remission
We now have some successful RCTs in scleroderma
Many trials were reported in SLE
However, what may be an important take home message is that if the doctor is non-adherent to treating to target when a paitent is not in remission, the consequences result in not obtaining remission for that patient. Not only that, the more often the doctor is non-adherent, the higher the chance of the patient not getting into remission in a dose-response fashion.
Ongoing adherence to a target yields better outcomes and this was shown in several studies including Walter Maksymowych's study (abstract #2912) of RA patients enrolled in the biomarker project. If the patient was not in remission, the doctor was notified. Consequences of not adhering to treat to target (i.e., not acting by altering therapy if a phone call was received) showed that the more often a doctor DID NOT adhere (i.e., did not treat to target), the more likely the individual patient was to NOT be in remission. Moreover, there was a dose response for MD non-adherence.
Maybe we should target the doctors instead of pointing a finger at the patients when it comes to non-adherence.
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio