Is the Difficult-to-Treat (D2T) concept applicable to axial spondyloarthritis?

Wendling, Daniel; Verhoeven, Frank; Prati, Clément

doi:10.1016/j.jbspin.2022.105512

Cited by 13 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, these two proposed criteria align with the one endorsed by EULAR for D2T-RA, which involves the failure of ≥2 b/tsDMARDs (with different MOAs), following the failure of a csDMARD [ 27 ]. Similarly, Wendling et al [ 28 ] advocated for a comparable approach in delineating D2T-axSpA, proposing the failure of either ≥2 b/tsDMARDs with different MOAs or ≥3 b/tsDMARDs regardless of their MOA, as criteria. However, as recently illustrated by a scoping review carried by our research team, there is still no consensus regarding the number of drugs that a patient must fail to be classified as D2T-PsA [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Ribeiro,

Singla,

Chandran

et al. 2024

Rheumatology Advances in Practice

View full text Add to dashboard Cite

Objectives This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)’s effort to define ‘difficult-to-treat’ PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA’s D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise. Methods An online survey was conducted among GRAPPA’s healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts’ viewpoints. Results About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action. Conclusion The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition.

show abstract

Section: Discussionmentioning

confidence: 99%

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Ribeiro,

Singla,

Chandran

et al. 2024

Rheumatology Advances in Practice

View full text Add to dashboard Cite

show abstract

“…However, the definition provided for a patient with RA needs to be further validated, discussed, and applied to PsA; some conceptual concerns will be raised due to the differences in terms of clinical phenotype and disease progression. These concerns have recently been raised in relation to axial spondyloarthritis [ 15 ]. First, given the multidomain nature of PsA and the various definitions used, axial involvement may be present in 5–70% of patients [ 16 ], and the use of csDMARDs is not recommended in these patients [ 16 ].…”

Section: Difficult To Treat and Refractory To Treatment: Any Differen...mentioning

confidence: 99%

Difficult to Treat and Refractory to Treatment in Psoriatic Arthritis

2023

View full text Add to dashboard Cite

Psoriatic arthritis (PsA) is a complex and chronic inflammatory condition in which the achievement of the best possible disease control has been proposed as the treatment target, which includes the possibility of reaching remission in all disease domains. However, due to the complexity of this multidomain disease, some patients may still have high disease activity in one or more domain and a high burden of disease, potentially leading to various treatment changes and to difficulty with the overall management. In this paper, we overview the concept of patients with difficult-to-treat PsA and the concept of patients with refractory-to-treatment PsA by providing a distinction between these two concepts and the possible implication for the management of patients with PsA.

show abstract

“…6 Difficult-to-Treat (D2T) concept has not been elaborated in axSpA and would be considered in the decision-making of tapering. 7 Disease activity-guided (DAG) tapering approach seemed to be favored over fixed dose approach in the real-world setting. In a retrospective study enrolled with 171 axSpA patients followed up for 44 months, DAG dose optimization with calculated daily defined dose (%DDD) of 62% had no negative impact on disease activity compared with full dose implementation.…”

Section: Personalized Tapering Of Tumor Necrosis Factor Inhibitor In ...mentioning

confidence: 99%

“…In IBD, dose de‐escalation of biologics would be preferred in a state of deep remission [clinical, biological, and endoscopic remission] and with drug trough level remaining within an appropriate target window 6 . Difficult‐to‐Treat (D2T) concept has not been elaborated in axSpA and would be considered in the decision‐making of tapering 7 …”

mentioning

confidence: 99%

Personalized tapering of tumor necrosis factor inhibitor in axial spondyloarthritis

Huang,

Lee,

Leong

et al. 2023

Int J of Rheum Dis

View full text Add to dashboard Cite

Is the Difficult-to-Treat (D2T) concept applicable to axial spondyloarthritis?

Cited by 13 publications

References 23 publications

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Difficult to Treat and Refractory to Treatment in Psoriatic Arthritis

Personalized tapering of tumor necrosis factor inhibitor in axial spondyloarthritis

Contact Info

Product

Resources

About