Optimizing Treat-to-Target in RA Save

Treat-to-target is a common management strategy for rheumatoid arthritis that aims to employ the strategy most effective in terms of achievement of optimal therapeutic outcomes in RA.

The definition of T2T is influenced by a choice of type of treatment, disease activity assessment toll, and the strategic attitude of the treating physician. T2T recommendations suggest a goal of significant improvement at 3 months and attainment of the treatment target at 6 months. At this time point, it remains unclear which patients will benefit from treatment escalation or from continuation of existing treatment.

This study done by Drs. Aletaha, Alasti and Smolen, provides the data basis to inform physicians about their clinical decision-making in an era when T2T in RA has become a widely accepted paradigm in the community. The data strengthen the 3-month time point as potentially decisive for a large number of patients, especially those who are targeting the goal of remission. After analyzing results of pivotal randomized controlled trials in RA (ASPIRE, ERA, PREMIER and IMAGE in early RA, and ATTRACT, DE019 and GO-FORWARD in established RA), the following conclusions were made:

• To be at least 80% sensitive for achieving the low disease activity (LDA) target at 6 months, a change at 3 months in Simplified Disease Activity Index/Clinical Disease Activity Index (SDAI or CDAI) of 58% needs to be observed by 3 months.
• Changes with 80% specificity while maintaining greatest were 65% for SDAI/CDAI and 40% for DAS28.
• To predict remission at 6 months, higher response levels are necessary at 3 months: 70% improvement in SDAI or CDAI (identical for 80% sensitivity and 80% specificity, and 34% (80% sensitivity) or 43% (80% specificity) for the DAS-based indices

They conclude that high level achievements at 3 months are needed to produe meaningful results (LDA or remission) at 6 months and beyond.