Thanks to significant advances in the care and treatment of patients with rheumatoid arthritis, many agree that the target of treatment should be to help patients achieve remission or low disease activity (LDA).1,2 As we will see at this year’s ACR Convergence 2020, various randomised control trials and other studies will report that a significant proportion of patients are achieving these stringent goals. A treat-to-target (T2T) approach is one way to guide patients toward these goals.
Numerous studies assessing outcomes in RA have demonstrated the multiple benefits of reaching a state of remission or LDA, which include3:
- Being a predictor of sustained clinical remission4
- Reducing disease activity and maintaining physical function5
- Reducing healthcare utilisation6
- Preserving working capacity7
- Decreasing mortality risk8
For this reason, the current EULAR and ACR guidelines both stress the importance of the T2T strategy in managing patients with RA.1,2 The principle of T2T involves4:
- Jointly deciding on a treatment target that is appropriate for the patient, considering their comorbidities and other patient factors
- Monitoring disease activity every 1 to 3 months
- Assessing whether the target of remission or LDA is reached
- If the target is reached, then continuing to monitor disease activity every 3 to 6 months
- If the target is not reached, then considering a therapy adjustment
Multiple clinical trials have demonstrated the benefits of a T2T approach. For example, the Tight Control in RA (TICORA) trial was one of the first to investigate the use of T2T with standard of care.9 In this study, patients were managed either with T2T with the goal of LDA or with routine care. Patients in the “tight control” group clearly demonstrated superior outcomes in EULAR good response, EULAR remission, and ACR 20/50/70 scores after 18 months compared with patients in the routine care group.9,10 This outcome, and similar results from other studies, provided the clinical evidence supporting the endorsement of a T2T approach by the ACR, EULAR, and other RA organisations (P < .0001).1,2,9-11 However, the implementation of T2T in clinical practice is varied.9-13 At the upcoming ACR Convergence 2020, new ACR guidelines for RA will be presented and will likely continue to support the T2T strategy.
Read Dr. Bernard Combe’s take on the emerging data and discussions around T2T in RA from the ACR Convergence 2020 meeting.
ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; RA, rheumatoid arthritis.
References: 1. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. Ann Rheum Dis. 2020; 79(6):685-699. 2. Singh JA, et al. Arthritis Care Res. 2016;68(suppl 1):1-15. 3. Combe B, Logeart I, Belkacemi MC, et al. Ann Rheum Dis. 2015;74(4):724-729. 4. Smolen J, Aletaha D, Bijlsma JW, et al. Ann Rheum Dis. 2010;69(4):631-637. 5. Monti S, Montecucco C, Bugatti S, Caporali R. RMD Open. 2015;1(suppl 1):e000057. 6. Ten Klooster PM, Oude Voshaar MAH, Fakhouri W, de la Torre I, Nicolay C, van de Laar MAFJ. Clin Rheumatol. 2019;38(10):2727-2736. 7. Kim D, et al. J Rheumatol. 2017;44(8):1112-1117. 8. van Nies JAB, van der Helm-van Mil AHM. Ann Rheum Dis. 2013;72(11):e25. 9. van Vollenhoven R. Nat Rev Rheum. 2019;15(3):180-186. 10. Grigor C, Capell H, Stirling A, et al. Lancet. 2004;364(9430):263-269. 11. Verstappen SM, Jacobs JWG, van der Veen MJ, et al. Ann Rheum Dis. 2007;66(11):1443-1449. 12. Harrold LR, Harrington JT, Curtis JR, et al. Arthritis Rheum. 2012;64(3):630-638. 13. Gvozdenovic E, Allaart CF, van der Heijde D, et al. RMD Open. 2016;2(1):e000221.