Impact of major Therapeutic Changes to Produce Significant C
A Study was conducted to examine the impact of major therapeutic change (MTC) on clinical response across a broad range of disease activity in US veterans with rheumatoid arthritis (RA).

Eligible patient visits were a rheumatology visit with 3 disease activity measures, including the Disease Activity Score in 28 joints, the Clinical Disease Activity Index, and the Routine Assessment of Patient Index Data 3; the follow-up visit for all 3 disease activity measures was 2–6 months later.

The full population and a subset of patients with active disease were evaluated. Clinical outcome was based on the American College of Rheumatology criteria for 20% improvement in disease activity (ACR20). The effect of MTC on ACR20 response was presented as crude descriptive statistics and evaluated using standardized regression for population- and disease activity–level conditional effects.

--The full population comprised 1,208 patients and the active disease subpopulation included 383 patients.

--Overall, visits with MTC were associated with increased likelihood of ACR20 response across all disease activity measures for the full population.

--Risk ratios for overall risk of ACR20 response for visits with MTC versus those without MTC ranged from 1.67 to 2.22 across disease activity measures among the full population and from 1.51 to 1.60 for the subpopulation with active disease.

In conclusion, the usefulness of therapeutic amendments for the established and active RA patients is also emphasized in MTC's clinical improvement, especially among patients having long-standing RA who receives several pre-therapies.