Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: results of the open-label, pragmatic, cluster-randomised TICOSPA trial

A. Molto*, C. Lopez-Medina, F.E. Van den Bosch, A. Boonen, C. Webers, E. Dernis, F.A. van Gaalen, M. Soubrier, P. Claudepierre, A. Baillet, M. Starmans-Kool, A. Spoorenberg, P. Jacques, P. Carron, R. Joos, J. Lenaerts, L. Gossec, S. Pouplin, A. Ruyssen-Witrand, L. SparsaA. van Tubergen, D. van der Heijde, M. Dougados

*Corresponding author for this work

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Abstract

Objectives To compare the benefits of a tight-control/treat-to-target strategy (TC/T2T) in axial spondyloarthritis (axSpA) with those of usual care (UC).Methods Pragmatic, prospective, cluster-randomised, controlled, open, 1-year trial (NCT03043846). 18 centres were randomised (1:1). Patients met Axial Spondylo Arthritis International Society (ASAS) criteria for axSpA, had an Ankylosing Spondylitis Disease Activity Score (ASDAS) >= 2.1, received non-optimal treatment by non-steroidal anti-inflammatory drugs and were biologic-naive.Interventions (1) TC/T2T: visits every 4 weeks and prespecified strategy based on treatment intensification until achieving target (ie, ASDAS <2.1); (2) UC: visits every 12 weeks and treatment at the rheumatologist's discretion.Main outcome Percentage of patients with a >= 30% improvement on the ASAS-Health Index (ASAS-HI). Other efficacy outcomes and adverse events were recorded. A health economic evaluation was performed.Statistical analysis Two-level mixed models were used to estimate efficacy outcomes. Cost-effectiveness was assessed by the incremental cost per quality-adjusted life-year (QALY) gained for TC/T2T versus UC.Results 160 patients were included (80/group). Mean (SD) age was 37.9 (11.0) years and disease duration was 3.7 (6.2) years; 51.2% were men. ASDAS at inclusion was 3.0 (0.7), and ASAS-HI was 8.6 (3.7). ASAS-HI improved by >= 30% in 47.3% of the TC/T2T arm and in 36.1% of those receiving UC (non-significant). All secondary efficacy outcomes were more frequent in the TC/T2T arm, although not all statistically significant. Safety was similar in both arms. From a societal perspective, TC/T2T resulted in an additional 0.04 QALY, and saved euro472 compared with UC.Conclusion TC/T2T was not significantly superior to UC for the primary outcome, while many secondary efficacy outcomes favoured it, had a similar safety profile and was favourable from a societal health economic perspective.
Original languageEnglish
Pages (from-to)1436-1444
Number of pages9
JournalAnnals of the Rheumatic Diseases
Volume80
Issue number11
DOIs
Publication statusPublished - 1 Nov 2021

Keywords

  • spondylitis
  • ankylosing
  • therapeutics
  • outcome and process assessment
  • healthcare
  • DISEASE-ACTIVITY SCORE
  • ANKYLOSING-SPONDYLITIS
  • PSORIATIC-ARTHRITIS
  • RHEUMATOID-ARTHRITIS
  • ADALIMUMAB
  • ASAS
  • RECOMMENDATIONS
  • IMPROVEMENT
  • CRITERIA
  • ABILITY

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