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ACR 2020 | Daily Highlights
Treat-to-Target
CLUSTER-RANDOMIZED PRAGMATIC CLINICAL TRIAL EVALUATING THE POTENTIAL BENEFIT OF A TIGHT-CONTROL AND TREAT-TO-TARGET STRATEGY IN AXIAL SPONDYLOARTHRITIS: THE RESULTS OF THE TICOSPA TRIAL
Abstract: 1444
Authors: Anna Molto et al.
Key content:
Tight control and treat-to-target strategies are well established in the treatment of RA. In analogy they have been recommended also for the treatment of spondyloarthritis, however, data supporting their efficacy is lacking. The TICOSPA trial is a pragmatic randomized trial comparing tight control with usual care in 160 patients with axial spondyloarthritis. Tight control (TC) consisted of clinical visits every 4wk, with therapy adaptation according to an ASDAS target of <2.1, whereas in usual care (UC) clinical visits were every 12wk with therapy decisions at the discretion of the rheumatologist. The primary outcome was significant improvement in the ASAS-HI score at 1 year follow up. The primary outcome was met in 47.3% with TC and 36.1% with UC, with no significant difference. However, secondary outcomes such as ASAS40 and BASDAI50 were met significantly more often with TC. 56.2% of the TC patients were on bDMARD versus 27.2% of UC patients.
Relevance:
This study is formally negative, as the primary endpoint was not met, despite a clearly higher use of bDMARD. However, several secondary outcome parameters showed significant benefit of TC and T2T strategies, which demonstrates that many patients need a more aggressive therapy. Further studies should analyze which patient subgroups with axSpA may benefit from TC and T2T strategies.
Zusammenfassung und Kommentar von:
Prof. Dr. Diego Kyburz
Basel
