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16-09-2019 | Rheumatology | News | Article

Early tight control strategy may not have long-term benefits for PsA patients

medwireNews: Follow-up results from the TICOPA study suggest no long-term clinical advantage of an early treat-to-target strategy for patients with psoriatic arthritis (PsA).

“The TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) study was the first strategy trial in PsA to demonstrate that a treat-to-target strategy in early disease improves clinical outcomes over a 48-week period,” but the present follow-up results suggest similar outcomes at 5 years regardless of whether patients received the tight control intervention or usual care, say the study authors.

For the follow-up study, Philip Helliwell (Chapel Allerton Hospital, Leeds, UK) and fellow researchers reviewed the case notes of 54 patients who were randomly assigned to the tight control intervention in the original trial (involving review very 4 weeks with treatment escalation if minimal disease activity criteria not met) and 56 participants who were given usual care.

Approximately 5 years after completing the TICOPA intervention, rates of low disease activity – defined as no tender or swollen joints, no active enthesitis or dactylitis, and no change or escalation of treatment – were comparable among patients in the tight control versus the usual care arm, at 69% and 76%, respectively.

Therefore, “[d]espite an early intervention at the time of diagnosis with a treat-to-target strategy for 1 year, the additional benefit identified in TICOPA at 48 weeks does not extend to a longer term advantage in disease activity once patients return to routine care,” write Helliwell and team in Rheumatology.

The proportion of patients receiving methotrexate at the 5-year follow-up was also similar among the tight control and usual care groups (44 vs 54%), as was the proportion taking biologics (54 vs 52%).

“Although no formal statistics have been performed, it is clear that there are no differences between the outcomes for PsA patients in the different arms of the study,” at the 5-year follow-up, say the researchers.

They add: “When evaluating these results, it must be noted that there was no formal intention to continue the treatment strategy, nor to continue detailed clinical and radiographic observations beyond the end of the TICOPA study.”

And the team concludes: “Other studies are needed to answer the question of the long-term benefits, including benefits on function and quality of life, of an early continuous treat-to-target strategy.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Rheumatology 2019; doi:10.1093/rheumatology/kez369

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