Does tight control of disease impede radiological progression? The radiographic outcomes of the TICOPA study

Objective

The Tight Control of Psoriatic Arthritis (TICOPA) study was the first to undertake the treat-to-target approach in psoriatic arthritis (PsA). Our aim was to further investigate the radiographic changes in the TICOPA study.

Methods

The TICOPA trial recruited patients with early treatment-naïve PsA. Plain radiographs of the hands and feet were taken at weeks 0 and 48. Clinical outcomes were recorded by a blinded assessor every 12 weeks. In post hoc analysis, bootstrapped quantile regression, adjusting for baseline values and minimization factors, was used to compare radiographic scores (modified Sharp/van der Heijde [mSvdH]), defined according to treatment arm or disease activity states.

Results

Paired baseline and week 48 radiographs were available for 169/206 (82%) at week 48 (84 tight control [TC] arm, 85 standard care [StdC] arm). There was no difference in change in total mSvdH score seen with TC compared to StdC (median [IQR] 0.0 [–2.0 to 0.5] vs 0.0 [–2.0 to 0.0]; difference 0.0 [95% CI 0.0-0.0]). Median total mSvdH score change was lower in those achieving minimal disease activity, Disease Activity in Psoriatic Arthritis remission, and very low disease activity. The number of people with radiographic progression (total erosion score of ≥ 2 at week 48) was numerically lower in the TC group (5/84 [5.9%] vs 12/85 [14.1%]). Patients with radiographical progression presented with polyarticular disease and high C-reactive protein, and had poorer clinical outcomes at weeks 12 and 24.

Conclusion

These data confirm the benefit of achieving low disease activity states on subsequent radiographic outcomes but did not show a significant impact related to a TC management approach.