SP0055 What are the challenges for applying treat to target in axial spondyloarthritis?

Background: One of the premises of the Treat to Target (T2T) is the shared treatment decision between the rheumatologist and the patient. For this reason, patient preferences play a fundamental role in the success of treatment in the short and long term. The aims of this study were to evaluate the treatment preferences of patients with Axial Spondyloarthritis (axSpA) and to identify the factors associated with their choice. Material and methods: Cross sectional study. Patients ≥18 years old that fulfilled the ASAS 2009 criteria for axSpA were included. Sociodemographic data, comorbidities, disease characteristics, and treatments received were recorded. A specially designed questionnaire in both, multiple choice modality and response mode listed in order of priority of the statements was administered. Statistical analysis: Descriptive statistics. Student’s T-test, Chi2 test and multiple logistic regression analysis. A value of p <0.05 was considered significant. Results: Seventy patients were included with a median age (m) of 46.5 years (IQR: 38-57), 55 males (78.6%) and a median disease duration of 13.5 years (IQR: 7.75-23.25). The relevant aspects for choosing a treatment were: the ability to improve the quality of life (32.9%), followed by improvement in joint inflammation (22.9%), pain (21. 4%) and physical function (14.3%). The chosen administration routes in decreasing order of frequency were: oral (51.4%), subcutaneous (SC) (41.4%), intramuscular (IM) 4.3% and intravenous (IV) 2.9%. The preferred frequency of oral administration was one tablet per week (61.1%) and SC administration, once a month (34.5%). The choice of oral route was associated with: preference for self-administration, preference for receiving the medication at home and higher level of education. The choice of the SC route was independently associated with the type of axSpA (AS) and a lower educational level. The patients under biological SC treatment and with lower disease activity, showed higher level of treatment satisfaction. Conclusion: The most preferred way of administration by patients with axSpA was the oral route. Lower disease activity and SC biological treatment were associated with treatment greater compliance.

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Treat-to-target strategy with secukinumab as a first-line biological disease modifying anti-rheumatic drug compared to standard-of-care treatment in patients with active axial spondyloarthritis: protocol for a randomised open-label phase III study, AScalate

BMJ Open ◽

10.1136/bmjopen-2020-039059 ◽

2020 ◽

Vol 10 (9) ◽

pp. e039059

Author(s):

Denis Poddubnyy ◽

Ludwig Hammel ◽

Marvin Heyne ◽

Justyna Veit ◽

Claudia Jentzsch ◽

...

Keyword(s):

Axial Spondyloarthritis ◽

Treatment Options ◽

Standard Of Care ◽

Phase Iii ◽

Treat To Target ◽

Institutional Review Boards ◽

Inadequate Response ◽

First Line ◽

Open Label ◽

Disease Modifying

IntroductionIn patients with axial spondyloarthritis (axSpA), biological disease-modifying anti-rheumatic drugs (bDMARDs) are recommended to those with inadequate response or contraindications to non-steroidal anti-inflammatory drugs (NSAIDs). In case of failure of the first bDMARD, a switch within the class or to other bDMARD is recommended. Despite these treatment options, there is no optimal treat-to-target (T2T) strategy. This study aims to evaluate the efficacy of a T2T strategy in patients with axSpA, with secukinumab as a first-line bDMARD, compared with standard-of-care (SOC) treatment.Methods and analysesThis is a randomised, parallel-group, open-label, multicentre ongoing study in patients with axSpA who are naïve to bDMARD and who have had an inadequate response to NSAIDs. The study will include an 8-week screening period, a 36-week treatment period and a 20-week safety follow-up period. At baseline, patients will be randomised (1:1) to T2T or SOC group. In the T2T group, patients will be treated with secukinumab 150 mg subcutaneous (s.c.) weekly until week 4 and then at week 8. For non-responders (patients without Ankylosing Spondylitis Disease Activity Score [ASDAS] clinically important improvement; change from baseline ≥1.1) at week 12, dose will be escalated to 300 mg s.c. every 4 weeks until week 24. Non-responders at week 24 will be switched to adalimumab biosimilar 40 mg s.c. every 2 weeks until week 34. In the SOC group, patients will receive treatment at the discretion of the physician. The primary endpoint is the proportion of patients achieving an Assessment in SpondyloArthritis International Society 40% (ASAS40) response at week 24.Ethics and disseminationThe study is being conducted as per the ethical principles of the Declaration of Helsinki and after approval from independent ethics committees/institutional review boards. The first results are expected to be published in early 2022.Trial registration numberThis study is registered with ClinicalTrials.gov, NCT03906136.

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Treat to target in axial spondyloarthritis: From its concept to its implementation

Journal of Autoimmunity ◽

10.1016/j.jaut.2019.102398 ◽

2020 ◽

Vol 110 ◽

pp. 102398 ◽

Cited By ~ 1

Author(s):

Maxime Dougados

Keyword(s):

Axial Spondyloarthritis ◽

Treat To Target

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Treat to Target in Axial Spondyloarthritis

Rheumatic Disease Clinics of North America ◽

10.1016/j.rdc.2019.07.003 ◽

2019 ◽

Vol 45 (4) ◽

pp. 519-535

Author(s):

Elena Nikiphorou ◽

Xenofon Baraliakos

Keyword(s):

Axial Spondyloarthritis ◽

Treat To Target

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POS0243 WHAT DOES REMISSION IN AXIAL SPONDYLOARTHRITIS MEAN FOR CLINICIANS? AN EXPLORATORY STUDY OF 200 FRENCH RHEUMATOLOGISTS BASED ON A VIGNETTE EXERCISE INCLUDING 36 CASES AND PRIORITY RATINGS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1019 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 343.1-343

Author(s):

K. Aouad ◽

D. Wendling ◽

A. Baglin ◽

M. Breban ◽

S. Dadoun ◽

...

Keyword(s):

Disease Activity ◽

Axial Spondyloarthritis ◽

Morning Stiffness ◽

Task Force ◽

Inactive Disease ◽

Treat To Target ◽

French Society ◽

Cross Sectional Survey ◽

Axial Pain ◽

A Priority

Background:Treat-to-target in axial spondyloarthritis (axSpA) aims to achieve and maintain clinical remission/inactive disease or alternatively, low disease activity [1]. However, there is no consensual definition of remission in axSpA: the T2T international task force has proposed Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease, but this definition is not widely accepted [1, 2].Objectives:To explore rheumatologists’ perception of remission in axSpA, using vignette cases and a priority exercise.Methods:A steering group of 7 rheumatologists designed a national cross-sectional survey during two face-to-face meetings in 2019-2020. The survey comprised 36 vignette cases: fixed elements included the clinical picture (34 year-old-male with confirmed axSpA, normal C-reactive protein (CRP), without synovitis, enthesitis, dactylitis or extra-articular manifestations) and there were 3 varying parameters (axial pain (0-10) [ranging 2 to 5], fatigue (0-10) [2 to 8], and morning stiffness [<15 minutes, 30 minutes or 1 hour]. For each vignette, the rheumatologist answered binarily: “do you consider this patient in remission: yes/no”. The second part of the survey comprised a priority rating (0-10 priority and 4 top items) of elements important to consider for remission, from a list of 12 items (BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAIDs use, extra-articular manifestations, and other explanations for the symptoms e.g., fibromyalgia). The analysis was descriptive.Results:Overall, 200 French rheumatologists participated between June and September 2020. Out of 2,400 vignette evaluations (mean of 66 evaluations per vignette), 463 (19%) were classified as remission by rheumatologists. Six vignette cases constituted 56% of all remission cases (Figure 1): these comprised a short duration of morning stiffness (<15 minutes), a low VAS axial pain (2 or 3) but with varying levels of VAS fatigue. When the duration of morning stiffness increased from 15 to 30 minutes and VAS axial pain increased from 2-3 to 4-5 independently, classification as remission decreased from 42% to 12% and from 28-33% to 5-11%, respectively. However, when VAS fatigue increased, it impacted less remission.In priority ratings, 4 items were selected as important by 68-75% of rheumatologists: morning stiffness and axial pain (both included in the vignettes), as well as extra-articular manifestations and NSAID use, whereas only 18% selected fatigue. BASDAI was cited as the 1st priority criteria by 24% of rheumatologists and ASDAS as the 2nd by 16% of rheumatologists.Figure 1.Frequencies of the declared remission states by rheumatologists for each of the 36 vignette casesConclusion:Morning stiffness, axial pain, NSAIDs use, and extra-articular manifestations seem to impact the physicians’ perception of remission in axSpA, whereas fatigue has less impact on remission for rheumatologists. Consensus is needed on remission in axSpA.References:[1Smolen JS et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis 2018;77:3–17.[2]Wendling D et al. 2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis. Joint Bone Spine 2018;85:275–84.Funding:This study was funded and organized by Novartis FranceDisclosure of Interests:Krystel Aouad: None declared, Daniel Wendling: None declared, Anne BAGLIN Employee of: Novartis, Maxime Breban: None declared, sabrina DADOUN: None declared, Christophe Hudry: None declared, Anna Moltó: None declared, Edouard Pertuiset: None declared, Laure Gossec: None declared

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