Treat-to-target care may be an effective option for patients with psoriatic arthritis, according to recent commentary published in The Lancet.

The treating-to-target strategy involves aggressively treating patients in order to reach a specific end point (eg, remission or low disease activity). Aggressive treatment end points are determined from findings of randomized controlled trials.

Results from the Tight Control of Rheumatoid Arthritis (TICORA) trial include 34% of patients achieving minimal disease activity with aggressive treatment. Favorable outcomes from the TICORA trial prompted Laura Coates from the University of Leeds and her colleagues to conduct the Tight Control in Psoriatic Arthritis (TICOPA) study.


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In the TICORA trial, researchers examined 206 patients in the United Kingdom who were diagnosed with psoriatic arthritis within 2 years of the start of the study and who had never received treatment with disease-modifying antirheumatic drugs.

The patients were randomly assigned to the tight-control group or the standard-care group. Patients in the tight-control group underwent monthly assessments, and their treatment was determined by a prescribed format to achieve minimal disease activity. The standard-care group was assessed every 3 months, and their treatment was determined by the treating rheumatologist.

The odds ratio of reaching the primary end point of an American College of Rheumatology 20% response (ACR20) at 48 weeks in the tight-control group vs the standard-care group was 1.91 (95% confidence interval [CI], P=.0392).

Other outcome measures including ACR50, ACR70, and the Psoriasis Area and Severity Index 75 (PASI75) all showed better improvement in the tight-control group vs standard care, but no improvement was seen in dactylitis or enthesitis.

An economic analysis revealed that the tight-control group was more expensive than standard care, and there was a higher incidence of adverse events in the tight-control group. However, no unexpected serious adverse events or deaths were reported.

“Coates and colleagues’ study is the first to test the concept of treat to target in psoriatic arthritis, and its findings suggest that the approach is appropriate,” the commentary concluded. “Further studies are needed to identify the most appropriate therapeutic interventions that should be used in the treat-to-target algorithm.”

Reference

Gladman DD. Is it time for treat to target in psoriatic arthritis? Lancet. 2015. doi: 10.1016/S0140-6736(15)00348-7.