Treat-to-target

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The term "Treat-to-Target" describes the targeted therapy that is used for various chronic diseases . The aim is to intervene in the course of the disease as early as possible and to influence it positively with the help of so-called DMDs ( disease modifying drugs ). The treat-to-target concept includes the definition of a specific therapy goal, regular monitoring of the therapy progress with regard to the treatment goal and, if necessary, an adjustment of the therapy in order to achieve the lowest possible disease activity or remission .

Targeted therapies represent new types of drug treatments . The active ingredients of the respective drugs target very specific processes in the patient's body that play an important role in the development of the disease itself or in a flare-up.

application

The origin of targeted therapies can be found in oncology (cf. targeted therapy ). The discovery of the principle for production of monoclonal antibodies by Kohler and Milstein and the description of HER2 - oncogene in breast cancer by Ullrich and Slamon in the 1980s led over the first approved antibody for the treatment of follicular lymphoma in the late 1990s and finally in 2000 in Germany for the first targeted antibody therapy against HER2-positive breast cancer. Since then, numerous targeted therapy concepts for breast, skin and lung cancer have been developed.

Targeted therapies have also become established in other indications . So this principle is in the field of cardiology for the arterial hypertension and particularly in relation to the treatment of dyslipidemia application and is in the guidelines of the European Society of Cardiology (ESC, Eng. European Society of Cardiology ) have been added.

The treat-to-target concept has now also proven itself for the treatment of type 2 diabetes . Studies have shown that individually adjusted insulin dosages based on a set algorithm represent a more efficient therapy strategy and thus enable many patients to be more effective and tolerable.

In rheumatology , the treat-to-target concept is now the therapy of choice for the indication of rheumatoid arthritis (RA) . Studies have shown that a treat-to-target strategy can improve the course of rheumatoid arthritis.

For many other rheumatological diseases , too , “treat-to-target” strategies are seen as desirable and targeted therapy concepts are discussed.

The PRO-KIND initiative (“Projects for Classification, Monitoring and Therapy in Pediatric Rheumatology”) of the Society for Child and Adolescent Rheumatology defined treatment options in a consensus paper, taking into account “treat-to-target strategies” for the treatment of systemic juvenile idiopathic disorders Arthritis (SJIA) with the active ingredient anakinra .

Individual evidence

  1. ↑ a b Josef S Smolen, Ferdinand C Breedveld, Gerd R Burmester, Vivian Bykerk, Maxime Dougados: Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force . In: Annals of the Rheumatic Diseases . tape 75 , no. 1 , January 2016, ISSN  0003-4967 , p. 3–15 , doi : 10.1136 / annrheumdis-2015-207524 , PMID 25969430 , PMC 4717393 (free full text) - ( bmj.com [accessed December 18, 2019]).
  2. ^ Georges Kohler: Derivation and Diversification of Monoclonal Antibodies . In: Scandinavian Journal of Immunology . tape 37 , no. 2 , February 1993, ISSN  0300-9475 , p. 120–129 , doi : 10.1111 / j.1365-3083.1993.tb01747.x ( wiley.com [accessed December 18, 2019]).
  3. ↑ RM Hudziak, GD Lewis, M Winget, BM Fendly, HM Shepard: p185HER2 monoclonal antibody has antiproliferative effects in vitro and sensitizes human breast tumor cells to tumor necrosis factor. In: Molecular and Cellular Biology . tape 9 , no. 3 , March 1989, ISSN  0270-7306 , p. 1165–1172 , doi : 10.1128 / MCB.9.3.1165 , PMID 2566907 , PMC 362707 (free full text) - ( asm.org [accessed December 18, 2019]).
  4. ↑ AJ Grillo-López, CA White, C. Varns, D. Shen, A. Wei: Overview of the clinical development of rituximab: first monoclonal antibody approved for the treatment of lymphoma . In: Seminars in Oncology . tape 26 , 5 Suppl 14, October 1999, ISSN  0093-7754 , p. 66-73 , PMID 10561020 .
  5. ↑ R. Hambrecht, C. Albus, M. Halle, U. Landmesser, H. Löllgen: Commentary on the new guidelines (2016) of the European Society for Cardiology (ESC) on cardiovascular prevention . In: The cardiologist . tape 11 , no. 1 , February 2017, ISSN  1864-9718 , p. 21–26 , doi : 10.1007 / s12181-016-0114-0 ( springer.com [accessed December 18, 2019]).
  6. ^ AJ Garber: Treat-to-target trials: uses, interpretation and review of concepts . In: Diabetes, Obesity and Metabolism . tape 16 , no. 3 , March 2014, p. 193–205 , doi : 10.1111 / dom.12129 , PMID 23668598 , PMC 4237121 (free full text) - ( wiley.com [accessed December 18, 2019]).
  7. ↑ C. Fiehn, J. Holle, C. Iking-Konert, J. Leipe, C. Weseloh: S2e guideline: Therapy of rheumatoid arthritis with disease-modifying drugs . In: Journal of Rheumatology . tape 77 , S2, August 2018, ISSN  0340-1855 , p. 35–53 , doi : 10.1007 / s00393-018-0481-y ( springer.com [accessed December 18, 2019]).
  8. ↑ M. Schneider, G.-R. Burmester: Treat-to-Target: therapeutic goals / prognostic parameters . In: Journal of Rheumatology . tape 78 , no. 5 , June 2019, ISSN  0340-1855 , p. 394–395 , doi : 10.1007 / s00393-019-0638-3 ( springer.com [accessed December 18, 2019]).
  9. ^ Society for Child and Adolescent Rheumatology: Commission PRO-KIND. In: https://www.gkjr.de . GKJR, accessed December 18, 2019 .
  10. ↑ PRO-KIND SJIA project collaborators, Claas H. Hinze, Dirk Holzinger, Elke Lainka, Johannes-Peter Haas: Practice and consensus-based strategies in diagnosing and managing systemic juvenile idiopathic arthritis in Germany . In: Pediatric Rheumatology . tape 16 , no. 1 , December 2018, ISSN  1546-0096 , p. 7 , doi : 10.1186 / s12969-018-0224-2 , PMID 29357887 , PMC 5778670 (free full text) - ( biomedcentral.com [accessed December 18, 2019]).
  11. ^ Nienke M. ter Haar, EH Pieter Dijkhuizen, Joost F. Swart, Annet Royen ‐ Kerkhof, Ayman el Idrissi: Treatment to Target Using Recombinant Interleukin ‐ 1 Receptor Antagonist as First ‐ Line Monotherapy in New ‐ Onset Systemic Juvenile Idiopathic Arthritis: Results From a five-year follow-up study . In: Arthritis & Rheumatology . tape 71 , no. 7 , July 2019, ISSN  2326-5191 , p. 1163–1173 , doi : 10.1002 / art.40865 , PMID 30848528 , PMC 6617757 (free full text) - ( wiley.com [accessed December 18, 2019]).