The ‘jury is still out’ on the best time to initiate aggressive therapy in patients with psoriatic arthritis, say researchers who carried out a long-term follow-up study on the benefits of early tight disease control.

Despite clear advantages shown in patients in a treat-to-target group at 48 weeks, the benefits had not been maintained compared with those treated with standard care when reviewed five years later.

Initial results from Tight Control of Inflammation in Early Psoriatic Arthritis (TICOPA) study reported that 40% of patients in the treat-to-target group had shown minimal disease activity compared with 25% in the control arm.

In the most recent update, published in Rheumatology, a review of 110 patients showed a current low disease activity of 69% in the tight control group compared with 76% in the standard treatment group.

At at the end of the original study more patients in the tight-control group were treated with biologics (33% vs 9%) but at the follow-up about half the patients in each group were using them.

Use of methotrexate had been similar in both groups in the initial study – which was done in treatment-naïve patients – and had dropped off in both in the years following (44% in the tight control group, 54% in standard group).

Study leader Professor Philip Helliwell, Professor of Clinical Rheumatology at the University of Leeds, said the results showed that in the years since the study, those who had initially received standard care had “caught up” with the tight control group not that those in the treatment arm had slipped back.

“The jury is still out we haven’t got a straightforward answer,” he told the limbic in an interview.

“We need to make judgements on an individual case-by-case basis. Treating everyone the same is not the right approach.”

Professor Helliwell said he hoped that other trials going on at the moment including work being led by his co-author Laura Coates at the Oxford Psoriatic Arthritis Centre would provide more answers in how best to stratify patients.