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09-11-2020 | ACR 2020 | Conference coverage | News

T2T strategy shows benefits for patients with axSpA

Author: Lucy Piper

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medwireNews: A treat-to-target (T2T) strategy has shown disease activity benefits for patients with axial spondyloarthritis (axSpA) in the TICOSPA trial, despite failing to achieve the primary quality of life outcome.

Presenting the findings at the ACR Convergence 2020 virtual meeting, Anna Moltó (Cochin Hospital, Paris, France) explained that recommendations for a T2T strategy in patients with axSpA are available, but that they are poorly implemented in clinical practice.

“One of the reasons might be that there is actually poor evidence in favor of the activity of such a strategy in patients with axial spondyloarthritis,” she suggested.


Anna Moltó on TICOSPA: Tight-control strategy shows favor in axSpA (6:24)

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To address this, Moltó and colleagues randomly selected 18 expert SpA centers in Belgium, France, and the Netherlands that agreed to deliver a T2T strategy or usual care to 160 biologic DMARD-naïve patients.

The 80 patients who received the T2T strategy at nine of these centers were monitored every 4 weeks with treatment intensified according to a recommended predefined strategy starting with two nonsteroidal anti-inflammatory drugs (NSAIDs) at full dose and changing to a first biologic and then a second biologic if a target ASDAS score below 2.1 points was not met.

By comparison, the 80 patients being treated at the nine usual care centers were monitored every 12 weeks and treatment was given at the discretion of the treating rheumatologist.

The findings showed that 47% of 80 patients participating in the T2T management strategy achieved the primary outcome of at least a 30% improvement on the ASAS-Health Index at 1 year.

This was higher than the 36% of 80 patients receiving usual care, “but this 11% difference […] was not statistically significant,” reported Moltó.

Nevertheless, she commented that significant differences were seen across many of the secondary outcomes for disease activity.

These included ASDAS low-disease activity (<2.1 points), achieved by 59.7% of T2T patients, compared with 50.8% of usual care patients at week 48, and ASAS 40 response rates at week 48, at 41.7% versus 27.1%, respectively.

These “in fact are the type of outcomes that were evaluated in previous T2T studies in rheumatology such as TICORA and TICOPA,” Moltó highlighted. Significant differences were also seen for BASDAI and BASDAI 50.

Despite significantly more patients in the T2T arm than the usual care arm receiving biologics, at 56.2% versus 27.5%, Moltó pointed out that the T2T strategy was cost-effective at a threshold of € 20,000 (US$ 23,777). And the probability of it being cost-effective compared with usual care was 72% from a societal perspective (healthcare plus social costs) and 52% from a healthcare only perspective.

In terms of safety, there were more adverse events in the T2T patients, at 33 versus 22 among the usual care group, but Moltó commented that this difference “was mainly driven by the number of allergies, which were skin reactions at the site of injection.”

The rates of infection were comparable at 15 in the T2T group and 16 in the usual care group, and the only two cases of severe infection were in the usual care group.

She concluded that usual care “was shown to be a very good treatment in this trial,” but “across all the efficacy outcomes there was a general trend in favor of T2T.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

ACR Convergence virtual meeting; 5–9 November 2020

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