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Recommendation
Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica
  1. Christian Dejaco1,2,
  2. Andreas Kerschbaumer3,
  3. Daniel Aletaha4,
  4. Milena Bond2,
  5. Elvis Hysa5,
  6. Dario Camellino6,
  7. Lisa Ehlers7,
  8. Andy Abril8,
  9. Simone Appenzeller9,
  10. Maria C Cid10,
  11. Bhaskar Dasgupta11,
  12. Christina Duftner12,
  13. Peter C Grayson13,
  14. Bernhard Hellmich14,
  15. Alojzija Hočevar15,16,
  16. Tanaz A Kermani17,
  17. Eric L Matteson18,
  18. Susan P Mollan19,20,
  19. Lorna Neill21,
  20. Cristina Ponte22,23,
  21. Carlo Salvarani24,25,
  22. Sebastian Eduardo Sattui26,
  23. Wolfgang A Schmidt27,
  24. Philip Seo28,
  25. Josef S Smolen29,
  26. Jens Thiel1,30,
  27. Carlos Enrique Toro-Gutiérrez31,
  28. Madeline Whitlock32,
  29. Frank Buttgereit33
  1. 1 Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria
  2. 2 Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
  3. 3 Abteilung für Rheumatologie, Medizinische Universitat Wien Universitatsklinik fur Innere Medizin III, Wien, Austria
  4. 4 Department of Rheumatology, Medizinische Universität Wien, Wien, Austria
  5. 5 Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, University of Genoa, Genova, Italy
  6. 6 Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Italy
  7. 7 Department of Rheumatology and Clinical Immunology, Charite Medical Faculty Berlin, Berlin, Germany
  8. 8 Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
  9. 9 Departamento de Clínica Médica. Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
  10. 10 Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
  11. 11 Rheumatology, Southend Hospital NHS Trust, Westcliff-on-sea, UK
  12. 12 Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
  13. 13 National Institutes of Health/NIAMS, Bethesda, Maryland, USA
  14. 14 Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany
  15. 15 Department of Rheumatology, Universitiy Medical Centre, Ljubljana, Slovenia
  16. 16 Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  17. 17 Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  18. 18 Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
  19. 19 Ophthalmology, University Hospitals Birmingham, Birmingham, UK
  20. 20 Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
  21. 21 Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Nethy Bridge, UK
  22. 22 Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
  23. 23 Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
  24. 24 Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
  25. 25 Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
  26. 26 Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  27. 27 Rheumatology, Immanuel Krankenhaus Berlin, Berlin-Buch, Berlin, Germany
  28. 28 Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  29. 29 Rheumatology, Medical University of Vienna, Wien, Austria
  30. 30 Clinic for Rheumatology and Clinical Immunology, University Hospital Freiburg, Faculty of Medicine, Freiburg, UK
  31. 31 Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia
  32. 32 Rheumatology, Southend University Hospital, Southend, UK
  33. 33 Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
  1. Correspondence to Dr Christian Dejaco, Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University of Graz, Graz, 8036, Austria; christian.dejaco{at}gmx.net

Abstract

Objectives To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).

Methods A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously.

Results Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment.

Conclusion These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

  • Giant Cell Arteritis
  • Polymyalgia Rheumatica
  • Biological Therapy
  • Outcome and Process Assessment, Health Care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/ard-2022-223429

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    Footnotes

    • Handling editor Mary K Crow

    • Twitter @profbdasgupta, @cristinadbponte, @SattuiSEMD, @philseo, @carlostororeuma

    • Contributors All authors were involved in the discussion and formulation of the recommendations. CDe wrote the first version of the manuscript. All authors reviewed it and made extensive comments and appropriate changes to it. All authors approved the final version of the manuscript.

    • Funding Funding was provided by AbbVie (ISM-51500).

    • Competing interests CDe has received consulting/speaker’s fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Sparrow, Roche, Galapagos and Sanofi, all unrelated to this manuscript. He is an editorial board member of ARD. AK has received consultancy fees, honoraria and travel expenses from AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, Janssen, Merck Sharp and Dohme, Novartis, UCB and Pfizer, all unrelated to this manuscript. He is an editorial board member of ARD. DA received grants, speaker fees, and/or consultancy fees from Abbvie, Amgen, Galapagos, Lilly, Janssen, Merck, Novartis, Pfizer, Sandoz and Sanofi. He is an editorial board member of ARD. MB has received consulting fees from AbbVie. DC has received speaker fees from Abiogen, BMS and GSK. MCC received consultancy and/or speaker fees from GSK, Vifor, Abbvie, Astra Zeneca and Janssen and a research grant form Kiniksa Pharmaceuticals. BD has received consultancies from Novartis, Abbvie, Roche and speaker agreements from Chugai. CDu has received consultancy or speaker fees and travel expenses from Abbvie, AOP Orphan, Astra-Zeneca, Bristol-Myers-Squibb, Eli-Lilly, Janssen, Galapagos, Merck-Sharp-Dohme, Novartis, Pfizer, Roche, Sandoz, UCB, Vifor and research support by Eli-Lilly, Pfizer, UCB, all unrelated to this manuscript. BH received speaker fees and/or consultancies from Abbvie, Amgen, Astra-Zeneca, BMS, Boehringer, Chugai, GSK, InflaRx, Janssen, MSD, Pfizer, Novartis, Phadia, Roche and Vifor. ELM has received consulting fees from Boehringer-Ingelheim, Horizon Therapeutics, Alvotech Inc; speaker fees from Boehringer-Ingelheim; royalties from UpToDate. SPM has received consultancy fees (Invex Therapeutics); advisory board fees (Invex therapeutics; Gensight) and speaker fees (Heidelberg engineering; Chugai-Roche Ltd; Allergan; Santen; Teva UK; Chiesi; and Santhera). All unrelated to this manuscript. LN has received consulting fees from AbbVie. CP is or has been the principal investigator of studies by AbbVie, Sanofi and Novartis and has received consulting/speaker’s fees from Vifor, AstraZeneca, GlaxoSmithKline and Roche, all unrelated to this manuscript. CS has received consultancy fees from Abbvie, Boehringer-Ingelheim, Eli Lilly, Galapagos, Novartis, Pfizer and Roche and royalties from UpToDate. All unrelated to this manuscript. SES has received research support by Astra-Zeneca and has done provided unpaid consultancy for Sanofi. SES is supported by the Rheumatology Research Foundation RISE pilot award and Bristol Myers Squibb Foundation Robert A Winn Diversity in Clinical Trials Career Development Award, outside of the submitted work. WAS has received consultancy fees, honoraria and travel expenses from Abbvie, Amgen, Bristol-Myers Squibb, Chugai, GlaxoSmithKline, Johnson & Johnson, Medac, Novartis, Roche, and Sanofi and is principal investigator in trials sponsored by Abbvie, Amgen, GlaxoSmithKline, Novartis, Roche and Sanofi. PS has received consultancy fees from Amgen and Janssen and royalties from UpToDate, all unrelated to this manuscript. JSS received grants to his institution from Abbvie, AstraZeneca, Lilly, Novartis and Roche and provided expert advice for, or had symposia speaking engagements with, AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celltrion, Chugai, Gilead, Janssen, Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, R-Pharm, Roche, Samsung, Sanofi and UCB. He is the editor in chief of ARD. JT has received consultancy or speaker fees Bristol-Myers-Squibb, Novartis, Glaxo-Smith-Kline, Astra-Zeneca, Janssen, Abbvie, Eli-Lilly. All unrelated to this manuscript. CET-G has received consultancy fees, honoraria and travel expenses from Abbvie, BMS, Boehringer Ingelheim, Biopas, Janssen, Pfizer, Pharmalab, Roche, all unrelated to this manuscript. FB has received consultancy fees, honoraria and travel expenses from Abbvie, Novartis, Pfizer, Roche and Sanofi, all unrelated to this manuscript. He is an editorial board member of ARD. EH, LE, AA, SA, PCG, AH, TAK and MW declare no competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.