Potential for Target-To-Treat Strategies for Polymyalgia Rheumatica and Giant Cell Arthritis

For older patients, polymyalgia rheumatica (PMR) and giant cell arthritis (GCA) tend to be overlapping inflammatory rheumatic disorders. Although the treatment span for patients varies most patients undergo glucocorticoid (GC) treatment for several years. After remission of PMR and GCA, lowering treatment toxicity and balancing the dose of GC becomes a high priority in patients. Patients who received GC treatment sometimes have treatment complications such as an inability to meet their treatment goals. The treat-to-target (T2T) approach for inflammatory rhematic disorders could achieve better clinical and structural outcomes for patients than the conventional GC treatment plan.

Researchers analyzed different abstracts to form an approach for T2T strategies. Abstracts such as EMBASE, SLR incorporated studies, and abstracts from the ACR and EULAR meetings were all analyzed. Four researchers and 2 methodologists assisted in the analysis. They identified 8 key areas of interest for treatment: population type and demographics, the amount of patients included and who received randomized treatment, intervention and treatment control, goals of treatment and treatment outcomes, how disease activity was monitored, adverse events, comorbidities, disease course predictions, effects of different treatment regimens, and the prognostic role of early vs established disease outcomes. They also analyzed bias risk with the Cochrane Collaborations Risk of Bias tool.

In their results, researchers found that 76 out of 7,809 provided references were eligible for this analysis. For PMR, 11 of these references were used. 54.5% of patients had low risk of biasand clinical improvement was a part of all the studies goals. Remission was also an outcome for 54.5% of the studies. For GCA, 46 references were used, and 7 articles were related to the GIACTA trial. Remission was a goal for 67.0% of the studies used.

Researchers were unable to identify a T2T strategy in this study, while analyzing previous studies’ GC treatment results. They theorize that one of the obstacles to T2T trials are the absence of an internationally recognized remission criteria. Remission is the most desirable target for patients with PMR or GCA. In their analysis, they found that there is a gap for individualized treatment for GC. T2T strategies may shorten that gap and could enhance patient’s quality of life.Researchers found that remission and relapse were only considered in half of the included studies, but relapse prevention and remission achievement were goals of all studies for GC treatment. In their analysis, they could not identify a T2T strategy study and believe that a trial is necessary to determine how the treatment could enhance overall quality of life, individualize treatment, and reduce side effects for patients. A T2T trial could also target new patients who were ineligible for GC treatment. To gather new data and information, a study with a focus on inflammatory rheumatic disorders would be necessary.

Reference

Hysa E, Bond M, Ehlers L, et al. Evidence on treat to target strategies in polymyalgia rheumatica and giant cell arteritis: A systematic literature review. Rheumatology Oxford. 2024;63(2):285-297. doi:10.1093/rheumatology/kead471