The time is NOW! Aiming for higher treatment targets in PsA and axSpA’ UCB-sponsored symposium was presented by Prof. Lars Erik Kristensen, Priv.-Doz. Dr Fabian Proft, Prof. Dr Denis Poddubnyy and Prof. Francesco Ciccia. Let’s have a closer look at the key takeaways from this symposium.

Raising the bar: Should we aim higher for our patients with PsA?

Prof. Lars Erik Kristensen

• Achieving higher treatment targets of MDA, DAPSA LDA and PASI 100 in PsA leads to fewer symptoms, reduces radiographic progression and improves overall patient quality of life. However, a large proportion of patients do not achieve these higher treatment targets in a real-world setting
• Of the 421 attendees, 39% voted that they would use MDA in an optimal setting to monitor disease activity in their patients with PsA, with 35% voting the same for DAPSA

Panel discussion: In which patients should we aim for high treatment targets?

• While the primary goal should be MDA or treating-to-target, the panel highlighted that we need to go deeper and analyse the impacts of specific symptom intensity on quality of life for individual patients
• Assessing patients on an individual basis is also important when considering whether to switch to a different therapy. For example, a patient who achieves clear skin and reduced CRP with therapy may not be recommended for treatment switching. However, some patients may still experience chronic pain and/or fatigue; therefore, these symptoms should also be considered and treated appropriately

Raising the bar: What is the optimal treatment target for patients with axSpA?

Priv.-Doz. Dr Fabian Proft

• Guidelines for axSpA recommend aiming for lower ASDAS scores; however, higher treatment targets in axSpA are often not achieved in the real world. Priv.-Doz. Dr Proft discussed discrepancies in the clinical measures of disease and objective signs of inflammation, and how measures of inflammation may be predictive of structural progression
• Of the 421 attendees, 76% agreed that the objective signs of inflammation (MRI and/or CRP) are as important as clinical response when monitoring patients with axSpA in clinical practice

• Priv.-Doz. Dr Proft summarised that a combination of measuring objective signs of inflammation and clinical response is key to understanding why some patients do not respond to specific treatment modalities

Panel discussion: Should treatment decisions be based solely on clinical response by PRO?

• MRI can be a valuable technique for monitoring patient response to treatment, particularly for patients who only experience a partial response. However, it was noted that it is not always practical to have every patient undergo MRI at every clinic visit, so some clinical judgement must be employed
• In addition to monitoring objective signs of inflammation, chronic pain should be considered when making treatment selections. Treatment interventions and exercise plans that can reduce pain, alongside physical and psychological support, can significantly improve patient care
• Evidence from dermatology colleagues shows that it is possible to switch between the currently available IL-17 inhibitors, rather than switching between therapeutic classes. Slight differences in binding to IL-17A cytokines suggest that, despite being in the same class, there will be nuances with each treatment

Why is aiming for higher treatment targets now more feasible than ever?

Prof. Dr Denis Poddubnyy

• The time is now to aim for higher treatment targets. Recent therapeutic innovations have provided additional options for patient management and made higher treatment targets a possibility in the clinic today
• Prof. Dr Poddubnyy closed with a summary of his final insights. The achievement of high treatment targets is now possible; patient outcomes can be improved with earlier diagnosis and the appropriate use of effective treatments now available to patients

Closing statement from the Chair

Prof. Francesco Ciccia

• To close our symposium, Prof. Ciccia stated “raising the bar should be the objective and our goal for the future. We need to be brave and have higher treatment targets for our patients with PsA and axSpA”