Treat-to-Target in Axial Spondyloarthritis: Are we there yet?

The Treat-to-target (T2T) strategy in axial spondyloarthritis (axSpA) stipulates that treatment should reach a predefined target and if not reached, intensification of therapy is implemented aiming at best future outcomes. Clinical remission was recommended by the 2017 international task force as the treatment target using Ankylosing spondylitis disease activity score (ASDAS) inactive disease, or alternatively, ASDAS low disease activity. The results of a recent T2T trial in axSpA were negative for the chosen primary outcome. Therefore, some concerns are still emerging regarding the optimal treatment target and the weak direct evidence proving the efficacy of such strategy. These challenges among others would preclude the application of T2T strategy in daily clinical practice. This review aims to highlight the updates of the T2T strategy in axSpA, giving an overview of the existing treatment targets, their potential benefits, and challenges to apply this strategy.