SAT0613 Depression and Cardiovascular Outcomes in Patients with Rheumatoid Arthritis (RA) Using A Treat-To-Target (T2T) Approach To Therapy versus Usual Care

BackgroundRA is an inflammatory autoimmune disease associated with increased prevalence of depression and cardiovascular comorbidities1,2. A T2T approach to therapy has been shown to significantly improve RA patient outcomes over usual care.ObjectivesTo compare incidence rates of depression and major cardiovascular events in RA patients with a T2T approach to therapy to a matched group of RA patients with usual care.MethodsThis retrospective cohort study used MarketScan administrative claims databases to select adults with at least 1 inpatient or 2 outpatient diagnoses of RA (ICD-9-CM 714.0x) at least 30 days apart and within a year during 1/1/2005 to 1/31/2014. The index event was the first biologic or non-biologic disease-modifying antirheumatic drug at least 6 months following diagnosis. Patients had 6 months of pre-index continuous enrollment and follow-up was variable in length with a 1 year minimum imposed (baseline year). Patients were categorized as having T2T approach if they had at 3 or more visits to a rheumatologist where the initial visit was within the first 90 days of follow-up and were determined to have low disease activity through implementation of a validated claims-based algorithm3 during the baseline year. Patients that did not meet both criteria were identified as having usual care. Incidence rates of depression (diagnosis or treatment) and major cardiovascular events (stroke or myocardial infarction) were calculated for the T2T cohort and the matched usual care cohort. Kaplan Meier (KM) method was used to examine the probability of time to event between groups.ResultsOf the 80,509 RA patients, 10.4% (N=8,333) were identified as having T2T based management strategy and matched 1:1 to 8,333 of the 72,174 (89.6%) patients with usual care. After matching both cohorts had similar demographic characteristics (e.g., mean age 57.5 years, 73% female).Compared to the usual care cohort, a significantly (p