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ESSAY

Treat-to-target in rheumatoid arthritis — are we there yet?

Abstract

Treat-to-target has been established as a guiding principle for the treatment of rheumatoid arthritis (RA) and encompasses several distinct elements: choosing a target and a method for measuring it; assessing the target at a pre-specified time point; a commitment to change the therapy if the target is not achieved; and shared decision-making. A treat-to-target approach yields superior outcomes to standard care in RA, and the ACR, EULAR and other professional organizations have endorsed treat-to-target as a fundamental therapeutic strategy for RA. Nevertheless, data on the degree to which treat-to-target is employed in the clinic are scarce; it seems that although some elements of treat-to-target are widely used, full implementation remains uncommon. Outstanding knowledge gaps to be addressed include how to select the right target for each patient, how often to assess whether the target has been achieved and the selection of each subsequent therapy in an evidence-based manner.

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Fig. 1: The meaning of treat-to-target.
Fig. 2: Treat-to-target in the EULAR treatment recommendations for RA.

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Correspondence to Ronald van Vollenhoven.

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R.v.V. declares that he has received research support and grants from AbbVie, Bristol Myers Squibb, GlaxoSmithKline, Pfizer and UCB and consultancy fees or honoraria from AbbVie, AstraZeneca, Biogen, Biotest, Bristol Myers Squibb, Celgene, Gilead, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer and UCB.

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Nature Reviews Rheumatology thanks S. Proudman, D. Porter and the other anonymous reviewer(s), for their contribution to the peer review of this work.

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van Vollenhoven, R. Treat-to-target in rheumatoid arthritis — are we there yet?. Nat Rev Rheumatol 15, 180–186 (2019). https://doi.org/10.1038/s41584-019-0170-5

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