Factors associated with ASDAS remission in a long-term study of ankylosing spondylitis patients under tumor necrosis factor inhibitors

Abstract

Objective: To determine the clinical and demographic factors associated with disease remission and drug survival in patients with ankylosing spondylitis (AS) on TNF inhibitors. Methods: Data from a longitudinal electronic database of AS patients under anti-TNF therapy between June/2004 and August/2013. Demographic, clinical parameters, disease activity by ASDAS remission (< 1.3) and inactive/low (< 2.1) were analyzed to characterize reasons for drug survival and switching of anti-TNF. Results: Among 117 AS patients, 69 (59%) were prescribed only one anti-TNF, 48 (41%) switched to a second anti-TNF and 13 (11%) to a third anti-TNF. Considering ASDAS-CRP < 1.3, 31 (39%) patients were inactive at the end of the study. Non-switchers (P = 0.04), younger age (P = 0.004), non-smoking (P = 0.016), shorter disease duration (P = 0.047), more frequent use of SSZ (P = 0.037) and lower BASDAI (P = 0.027), BASMI (P = 0.034) and BASFI (P = 0.003) at baseline were associated with remission. In the multivariate analysis younger age (P = 0.016) and lower BASDAI (P = 0.032) remained as remission predictors. Conclusion: This study supports that ASDAS-CRP remission is an achievable goal not only for non-switchers but also for second anti-TNF, particularly in patients with younger age and lower BASDAI at baseline. Comedication and non-smoker status seems to have a beneficial effect in anti-TNF response in this population.

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study

“…Among sex, age, and disease duration, only female sex showed a significant association, with a greater burden of residual disease in the LDA subgroup. These results are in contrast with previous observations where, among other variables, younger age, shorter disease duration, and LDA at baseline were associated with ASDAS remission [ 28 ].…”

Role of Metrology in Axial Spondyloarthritis: Does It Provide Unique Information in Assessing Patients and Predicting Outcome? Results From the British Society for Rheumatology Biologic Register for Ankylosing Spondylitis

“…Only a few studies have examined whether the BASMI score is a predictor of treatment response; in a study of 624 participants with axial SpA in Switzerland who were starting TNF inhibitor (TNFi) therapy, a high BASMI score was a significant predictor of not satisfying the ASAS40 response criteria at 1 year follow‐up (OR 0.76 per unit increase [95% CI 0.63, 0.90]) (40). The BASMI score on commencing TNFi therapy was a predictor of better physical function and spinal mobility at 3‐year follow‐up in a study of 257 patients with AS from The Netherlands (41), but the BASMI score was not an independent predictor of inactive disease (defined by ASDAS <1.3) in a study of 117 patients with AS treated with TNFi in Brazil (42). All these results are in agreement with those from the current study.…”

It Is High Time That We Define Axial Psoriatic Arthritis

“…Smoking is an important environmental risk factor for the development of psoriasis, PsA, and AS and is associated with worse outcomes 8,9,10,11,12 . With the hypothesis that similar risk factors may operate in the development of AS and axPsA, Solmaz, et al have investigated the association between smoking and axPsA in a large prospective, multicenter PsA registry.…”