Early axial spondyloarthritis according to the ASAS consensus definition: characterisation of patients and effectiveness of a first TNF inhibitor in a large observational registry

Abstract

ObjectiveTo characterise the population fulfilling the Assessment of SpondyloArthritis international Society (ASAS) consensus definition of early axial spondyloarthritis (axSpA) and to determine the effectiveness of a first tumour necrosis factor inhibitor (TNFi) in early versus established axSpA in a large observational registry.MethodsA total of 3064 patients with axSpA in the Swiss Clinical Quality Management registry with data on duration of axial symptoms were included (≤2 years=early axSpA, N=658; >2 years=established axSpA, N=2406). Drug retention was analysed in patients starting a first TNFi in early axSpA (N=250) versus established axSpA (N=874) with multiple-adjusted Cox proportional hazards models. Adjusted logistic regression analyses were used to determine the achievement of the ASAS criteria for 40% improvement (ASAS40) at 1 year.ResultsSex distribution, disease activity, impairments of function and health-related quality of life were comparable between patients with early and established axSpA. Patients with established disease were older, had more prevalent axial radiographical damage and had a higher impairment of mobility. A comparable TNFi retention was found in early versus established disease after adjustment for age, sex, human leucocyte antigen-B27 status, education, body mass index, smoking, elevated C reactive protein and sacroiliac inflammation on MRI (HR 1.05, 95% CI 0.78 to 1.42). The adjusted ASAS40 response was similar in the two groups (OR 1.09, 95% CI 0.67 to 1.78). Results were confirmed in the population fulfilling the ASAS classification criteria.ConclusionConsidering the recent ASAS definition of early axSpA, TNFi effectiveness seems comparable in early versus established disease.

The failure of biological treatment in axial spondyloarthritis is linked to the factors related to increased intestinal permeability and dysbiosis: prospective observational cohort study

“…Similarly, in another study, concomitant diseases were associated with worse treatment effects with TNFi in axSpA [47]. In our study concomitant diseases did not significantly increase this risk (OR = 2.03, 95% CI 0.22 − 18.77, p = 0.53).…”

“…Zonulin was significantly correlated with CRP, although CRP alone was not associated with treatment response. This is a different result from most studies, which have shown the superiority of increased CRP in predicting good response to bDMARDs, especially TNFi [29,30,47,48]. However, higher values of the inflammatory indices (WBC, CRP, ESR) reduced the risk of poor response, but not significantly.…”