Finding the Panacea

Treat to Target

With respect to treatment goals, Dr. Coates stressed the importance of a treat-to-target strategy.

This approach is exemplified by the TICOPA (Tight Control of Psoriatic Arthritis) study, a multi-center, open label, randomized clinical trial of 206 patients with early PsA. In the controlled, parallel group study, patients in the tight-control group were evaluated every four weeks, with therapy escalating if minimal disease activity was not achieved. Meanwhile, the standard-care group was evaluated every 12 weeks and had clinician-guided therapy.⁸

At week 48, the odds of achieving an ACR20 response were nearly double in the tight-control group compared with the standard-care group. Improvements were also seen across multiple composite disease activity measures in the tight-control group. The study’s intensive approach led to more rapid and sustained disease control, but a higher rate of mild to moderate adverse events was seen in the study.⁸

In Sum

Dr. Coates’ session covered a great deal of ground, which makes sense in the context of a disease as multi-faceted as PsA. Although we still have a lot to learn about managing this condition, the thoughtful lecture provided insights that can be applied in the clinic here and now.

Jason Liebowitz, MD, FACR, is an assistant professor of medicine in the Division of Rheumatology at Columbia University Vagelos College of Physicians and Surgeons, New York.

References

1. Charlton R, Coates L, Galloway J, et al. Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: A nested matched cohort study from within the U.K. National Early Inflammatory Arthritis Audit [abstract 1613]. Arthritis Rheumatol. 2022;74(suppl 9).
2. Gossec L, Coates LC, Gladman DD, et al. Treatment of early oligoarticular psoriatic arthritis with apremilast: primary outcomes at week 16 from the FOREMOST randomised controlled trial. Ann Rheum Dis. 2024 Oct 21;83(11):1480–1488.
3. Gossec L, Kerschbaumer A, Ferreira RJO, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. 2024 May 15;83(6):706–719.
4. Baraliakos X, Gossec L, Pournara E, et al. Secukinumab in patients with psoriatic arthritis and axial manifestations: Results from the double-blind, randomised, phase 3 MAXIMISE trial. Ann Rheum Dis. 2021 May;80(5):582–590.
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6. Mulder MLM, Vriezekolk JE, van Hal TW, et al. Comparing methotrexate monotherapy with methotrexate plus leflunomide combination therapy in psoriatic arthritis (COMPLETE-PsA): A double-blind, placebo-controlled, randomised, trial. Lancet Rheumatol. 2022 Apr;4(4):e252–e261.
7. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017 May 25;376(21):2095–2096.
8. Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): A U.K. multicentre, open-label, randomised controlled trial. Lancet. 2015 Dec 19;386(10012):2489–2498.