Treat-to-target: A promise in axial spondyloarthritis

Patients with axial spondyloarthritis could benefit from a treat-to-target concept similarly applied in rheumatoid arthritis patients. This approach is supported by the TICOSPA study.

A new approach for treatment according to target values

Patients with axial spondyloarthritis could benefit from the treat-to-target concept in a similar way to patients with rheumatoid arthritis. This approach is supported by the results of the French  "Tight Control in Spondyloarthritis" (TICOSPA) study.

The treat-to-target approach is well established for diseases such as high blood pressure, diabetes and rheumatoid arthritis. Here, the therapy is based on clearly defined target values. This is not yet the case with axial spondyloarthritis.

The recently published results of the French TICOSPA study now suggest that treat-to-target may also be clinically meaningful and cost-effective for people with axial spondyloarthritis.

Therapy depends on the ASDAS score

TICOSPA took place at specialised centres in France, Belgium and the Netherlands. Two parameters played a role:

A total of 160 test subjects with axial spondyloarthritis and an ASDAS > 2.1 were included in the study. Half of the participants were assigned to a TC (tight control) arm and the other half to a UC (usual care) arm. In each group, 72 people completed the follow-up over one year.

In the TC arm, the treatment goal was clearly defined with an ASDAS < 2.1. For each increase > 2.1, the therapy was escalated according to a schedule. In the UC arm, on the other hand, the medication was adjusted as usual by the clinical assessment of the rheumatologists.

Study trends expose success

The primary endpoint in TICOSPA was a 30% improvement in ASAS after one year of follow-up. This endpoint was achieved by 47% of the participants in the TC arm and 36% in the UC arm (statistically not significant). Scores on disease activity and quality of life also showed a trend towards TC therapy.

Model calculations on cost-effectiveness also showed that the treat-to-target approach is cost-saving overall, although biologics were prescribed significantly more frequently in the TC group (56% TC versus 27% UC). According to the authors, this could be due to savings in rehabilitation costs and sick days.

A future availability in everyday practice?

The treat-to-target concept is not yet part of everyday practice in the treatment of patients with axial spondyloarthritis. This could change in the future on the basis of the present study. However, the authors agree that further studies must first follow to check and verify this strategy.

However, it will not be easy to integrate constant care, such as the TC arm with outpatient visits every 4 weeks, into the daily routine of a rheumatology practice.

1. Clinical trial establishes benefits of treat-to-target in axial spondyloarthritis EUROPEAN E-CONGRESS OF RHEUMATOLOGY 2020, from 3 June...
2. Mitchel Zoler; TICOSPA: Efficacy of treat-to-target strategy suggested in axial spondylarthritis, June 11, 2020, Conference Coverage

* ASDAS includes questions on back pain, joint swelling and the duration of morning stiffness. The CRP value is also included in the score. An ASDAS > 2.1 stands for high disease activity.