Task Force Publishes Target-To-Treat Guidance for GCA and PMR

An international task force recently published the first target-to-treat (T2T) recommendations for patients with giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) in the Annals of the Rheumatic Diseases.

“Up to now, T2T is not a recognized treatment approach in GCA and PMR, and to this point there has not been a systematic evaluation and consensus finding process on this topic,” wrote corresponding author Christian Dejaco, MD, PhD, MBA, of the Medical University of Graz in Austria. “The development of T2T recommendations for GCA/PMR, therefore, addresses a current unmet medical need.”

A 29-person task force, consisting mostly of physicians, reviewed evidence and provided expert opinion for the development of recommendations. Consensus on the final recommendations was obtained through discussion and voting.

The recommendations specify remission, defined as the absence of clinical symptoms and systemic inflammation, as the treatment target in GCA and PMR. Additionally, GCA treatment should aim to prevent tissue ischemia and vascular damage.

Treatment selection in GCA and PMR should be based on disease severity and activity, comorbidities, and outcome predictors, with as-needed modifications over follow-up, according to the guidance. Comorbidities may affect treatment target assessment and should be considered before treatment modifications are made; the recommendations advise.

Finally, the minimal effective dose of medication, if any, should be used to maintain remission. Afterward, disease activity should be regularly monitored.

The paper also proposes a GCA and PMR research agenda to address gaps in the current evidence.

“Despite the limited evidence, we expect these T2T recommendations [to] contribute to high-quality clinical care in GCA and PMR…” researchers wrote. “We anticipate that new developments in the management and assessment of disease states and outcomes will take place in the coming years, which will affect these recommendations and necessitate amending them.”

Reference

Dejaco C, Kerschbaumer A, Aletaha D, et al. Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica. Ann Rheum Dis. 2024;83(1):48-57. doi:10.1136/ard-2022-223429