Treat-to-target in psoriatic arthritis-cost-effective in the biosimilar era.

Abstract

For more than a decade the concept of treat-to-target has become accepted as a treatment strategy for people with inflammatory arthritis. The benefit of tight control was first seen in the Tight Control of Rheumatoid Arthritis (TICORA) study in 2009 before the availability of biologics. 1 Grigor C Capell H Stirling A et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004; 364: 263-269 Summary Full Text Full Text PDF PubMed Scopus (1222) Google Scholar In 2015, the Tight Control of Psoriatic Arthritis (TICOPA) study confirmed the benefit of treat-to-target in patients with psoriatic arthritis, with a combination of conventional synthetic and biological disease-modifying antirheumatic drugs (DMARDs). The TICOPA study demonstrated the benefits of treat-to-target for patients in the primary outcome, which was the American College of Rheumatology (ACR) 20, as well as in many secondary outcomes (ACR50 and ACR70, psoriasis area and severity index outcomes, and functional ability). 2 Coates LC Moverley AR McParland L et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015; 386: 2489-2498 Summary Full Text Full Text PDF PubMed Scopus (315) Google Scholar On this basis, treat-to-target in psoriatic arthritis has been incorporated in international guidance for 7 years. Yet, the rates of implementation of treat-to-target remain low in routine clinical practice, with the cost of biologics being a potential barrier.