A report, published in Annals of the Rheumatic Diseases, disputed recent recommendations to use a treat-to-target strategy (T2T) in patients with axial spondyloarthritis (axSpA). Researchers, headed by Anna Molto, MD, PhD, from the Rheumatology Department at Hospital Cochin in Paris, France, compared a tight-control/treat-to-target strategy (TC/T2T) against usual care (UC), and found that TC/T2T did not produce significant benefits over UC percentage of patients who achieved a 30% or greater improvement on the Axial Spondylo Arthritis International Society-Health Index (ASAS-HI).

While TC/T2T was not superior to UC in the study’s primary endpoint, it was advantaged in all the secondary efficacy outcomes and displayed a similar safety profile with evidence of favorable economic characteristics, reported Dr. Molto.

The study formed equal arms out of participants that met ASAS criteria for axSpA, had an Ankylosing Spondylitis Disease Activity Score (ASDAS) of 2.1 or more, and had received anti-inflammatory drugs, but not biologics.

The TC/T2T arm performed visits every four weeks with a prespecified intensification strategy until they achieved a treatment target (ASDAS < 2.1). The UC arm performed visits every 12 weeks with treatment at the rheumatologist’s discretion. Cost-effectiveness was assessed by the incremental cost per quality-adjusted life-year (QALY) gained for TC/T2T versus UC.

Mean ASDAS at inclusion was 3.0 (standard deviation [SD] = 0.7), and ASAS-HI was 8.6 (SD = 3.7). Though the difference was not significant, ASAS-HI improved by 30% or more in 47.3% of the TC/T2T patients versus in 36.1% of the UC patients. TC/T2T resulted in an additional 0.04 QALY, and saved €472 compared with UC.

Given the potential of the TC/T2T approach observed in the study, Dr. Molto assessed that it “might be beneficial in axSpA, but other strategy trials for this disease aiming to evaluate the efficacy of TC/T2Tin this setting are needed to build on our findings.”

Source: Annals of the Rheumatic Diseases