The results from a similarly designed trial in ankylosing spondylitis were more complex. In comparing a tight-control/treat-to-target strategy in axial SpA with usual care, Molto et al. did not find a statistically significant difference between treatment groups using the primary endpoint of the percentage of patients with a greater than 30% improvement on the ASAS-Health Index (ASAS-HI). However, the authors wrote that the tight-control/treat-to-target group did achieve more favorable secondary efficacy outcomes, had a similar safety profile and was more cost effective at one year than the group receiving usual care.5 These findings may indicate a role for treat-to-target and tight control approaches in ankylosing spondylitis management.
Dr. Van den Bosch ended his talk with the concept of the DEER approach, which stands for dedicated, empathic and educated rheumatologist. This approach means rheumatologists should keep in mind such issues as mental health, socioeconomic factors, central pain sensitization syndromes, such as fibromyalgia, and comorbidities that may affect a patient’s likelihood to respond or not respond to treatment.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Vandendorpe AS, de Vlam K, Lories R. Evolution of psoriatic arthritis study patient population characteristics in the era of biological treatments. RMD Open. 2019 Jan 22;5(1):e000779. eCollection 2019.
- van der Heijde D, Baraf HS, Ramos-Remus C, et al. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: Results of a fifty-two-week, randomized, controlled study. Arthritis Rheum. 2005 Apr;52(4):1205–1215.
- Mease PJ, Smolen JS, Behrens F, et al. A head-to-head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naive patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial. Ann Rheum Dis. 2020 Jan;79(1):123–131.
- Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): A U.K. multi-centre, open-label, randomised controlled trial. Lancet. 2015 Dec 19;386(10012):2489–2498.
- Molto A, López-Medina C, Van den Bosch FE, et al. Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: Results of the open-label, pragmatic, cluster-randomised TICOSPA trial. Ann Rheum Dis. 2021 May 6:annrheumdis-2020-219585. Epub ahead of print.