Optimisation of a treat-to-target approach in XXXX : strategies for the 3-month time point.

@entity1 @entity8168 @entity309
BACKGROUND: Treat-to-target (T2T) is a widely accepted management strategy for @entity309 ( @entity309 ) with a key decision point at 3   months after treatment initiation. At this time point, it remains unclear which @entity1 will benefit from treatment adaptation or from continuation of existing treatment. METHODS: We performed a pooled analysis of @entity1 -level clinical trial data of @entity1 with @entity309 . We used a diagnostic testing methodology and a probabilistic approach employing logistic regression to investigate which levels of response at 3 months can inform treatment decisions in regard to achieving the target at 6   months. RESULTS: To be at least 80% sensitive for achieving the low disease activity (LDA) target at 6   months, a change at 3   months in Simplified Disease Activity Index/Clinical Disease Activity Index (SDAI or CDAI) of 58% needs to be observed at 3   months. Higher changes are needed to sensitively predict @entity8168 ( @entity8168 ). Not reaching the (minor) SDAI 50% response level is afflicted with very low negative likelihood ratios (LRs) (0.28 for LDA and 0.07 for @entity8168 at 6   months). Experiencing (major) SDAI 85% response has substantial positive LRs of 9.2 for reaching LDA and 6.2 for reaching @entity8168 at 6   months. In logistic regression, the change at 3   months is significantly associated with reaching of the target at 6   months. CONCLUSIONS: The 3-month time point is a critical decision point. Not achieving minor responses at 3   months makes reaching of the treatment target at 6   months highly unlikely, while reaching major responses is highly predictive of reaching the treatment target.
