The concept of Treat to Target (T2T) applied in rheumatoid arthritis has been evaluated in psoriatic arthritis and is currently under investigation in two different strategy trials in patients suffering from axial spondyloarthritis (axSpA). Whatever le results of these trials will be, the acceptation of this concept and consequently its implementation in daily practice might be challenging for several reasons.
The concept of T2T necessitates 3 different steps and also the close collaboration of the patient and the availability of different treatment modalities.
The three different steps consist in:
a) the choice of the most relevant outcome measure (e.g. a measure evaluating a domain recognized as predisposing to subsequent clinically relevant damage (either structural damage or important comorbidities such as cardiovascular diseases)).
b) the determination of the threshold of the outcome measure to reach (threshold below which the risk of subsequent damage is abolished or significantly decreased).
c) The time to reach the target is usually related to the treatment modality (a few days for NSAIDs and several weeks for DMARDs).
A part these different steps, two points have to be considered a) this T2T approach is impossible without embarking the patient in a true share decision b) this T2T strategy requires the possibility to adapt/increase the treatment in case the target is not reached after one or several “conventional” treatment modalities.
For each of these different points we will consider past-on ongoing initiatives proposing to resolve the different encountered issues in order to facilitate the elaboration and the implementation of a T2T strategy in AxSpA.
Disclosure of Interest M. Dougados Grant/research support from: UCB,ABBVIE,PFIZER,MERCK, Consultant for: UCB,ABBVIE,PFIZER,MERCK