Professor Walter Maksymowych - Treat-to-target strategy



Professor Walter Maksymowych talks about the concept of treat-to-target.


About the speaker

Walter Maksymowych is a Professor of Rheumatology at University of Alberta, Canada. He is also the Medical Scientist of the Alberta Heritage Foundation for Medical Research.



Treat-to-target is a very important concept for rheumatologists because we know from the study of diseases like rheumatoid arthritis that if you treat to a target, and in rheumatoid arthritis it's the disease activity score, then the outcomes for patients are much better, so patients who are treated with this strategy have much better functional outcome and much less structural damage, so we're very interested in exploring this concept in spondyloarthritis.

There's a very big challenge, however, in the field because the structural target that we evaluate is spinal ankylosis and to detect change in spinal ankylosis you have to wait for years and now with the knowledge about the enhanced sensitivity of MRI, we're now exploring MRI as a way of measuring structural changes in patients with spondyloarthritis.

In this study, we used MRI to evaluate structural changes in spondyloarthritis and we specifically focused on erosion and then we looked at the EMBARK study cohort. There were 161 patients who were treated for up to two years with Etanercept and we compared this cohort with a group of patients who were recruited into the DESIR study cohort and this is a french cohort of patients with very early axial spondyloarthritis.

We wanted to see if those patients who achieved a very low level of disease activity as measured using the ankylosing spondylitis disease activity score. We wanted to see if those patients who had sustained remission over at least six months had less structural damage on MRI, so that was the hypothesis we were testing.

What we were able to show was that in both cohorts those patients who maintained low disease activity for a period of at least six months had the least structural damage. They had resolution of erosion in some cases, but certainly reduction in erosion.

They also had repair features, so we see that these patients are not only reducing the extent of erosion, but there is a repair tissue that appears at the site of the erosion cavity in the sacroiliac joint and this all more prominent in patients who achieve low sustained disease activity. This is very important. It's the very first evidence that suggests that by targeting disease activity to a very low state and keeping it there may be a very important strategy for treating patients with axial spondyloarthritis.


PP-ENB-GBR-0765 | March 2018