‘Aggressive therapy’ key in axial spondyloarthritis despite lack of T2T recommendation

ByErich Martin

Fact checked byPatricia Nale, ELS

SAN DIEGO — Although current American College of Rheumatology guidelines eschew treat-to-target for axial spondyloarthritis, “aggressive treatment” is still needed to manage the disease, noted a speaker here.

“The 2019 ACR treatment guidelines say treat-to-target is not yet ready for prime time in axial spondyloarthritis,” Atul Deodhar, MDMRCP, of Oregon Health and Science University, told attendees at the Congress of Clinical Rheumatology West. “However, aggressive therapy is still important.”

Although current ACR guidelines eschew treat-to-target for axial SpA, “aggressive treatment” is still needed to manage the disease, according to a speaker at the Congress of Clinical Rheumatology West. *Source: Adobe Stock*

Whether treating axial SpA or non-radiographic axial SpA, recommendations for management are similar, Deodhar said. Tumor necrosis factor (TNF) inhibitors should be used before secukinumab (Cosentyx, Novartis) or ixekizumab (Taltz, Eli Lilly). Additionally, those drugs should be used before a second TNF inhibitor in patients who do not respond to the first TNF inhibitor, Deodhar added, referencing 2019 guidelines for the management of axial SpA and non-radiographic SpA.

Atul Deodhar

Similarly, co-administration of methotrexate with TNF inhibitors, using a strict treat-to-target strategy and discontinuing biologics in patients demonstrating stable disease, is not recommended.

“Co-administration of low-dose methotrexate with a TNF inhibitor is not recommended,” Deodhar said. “We do not need methotrexate.”

Routine X-rays of the spine should also be avoided in the course of routine disease management and monitoring, he added.

“Routine spinal x-rays should not be done, this is not rheumatoid arthritis,” Deodhar said. “It does not really tell us anything more.”

Although treat-to-target strategies are not currently recommended, there is room for revision when new guidelines are developed, according to Deodhar.

In cases when patients fail to respond to recommended therapies, Deodhar recommended rheumatologists reevaluate the situation, consider the diagnosis, and consider whether the disease is still active and whether treatment is for inflammation or damage.

“Everybody wants a cure, but we don’t get cures in rheumatology,” Deodhar said. “Drug-free remission is as close to a cure as we can get.”

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Sources/Disclosures

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Source:

Deodhar A. Spondyloarthritis 2022. Presented at: The Congress of Clinical Rheumatology West; Oct. 20-23, 2022 (hybrid meeting).

Disclosures: Deodhar reports financial disclosures with AbbVie, Amgen, Aurinia, Bristol-Myers Squibb, Celgene, Eli Lilly, GlaxoSmithKline, Janssen, MoonLake, Novartis, Pfizer and UCB.

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‘Aggressive therapy’ key in axial spondyloarthritis despite lack of T2T recommendation

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