Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry

Tužil, Jan; Mlcoch, T.; Jirčíková, Jitka; Závada, Jakub; Nekvindová, Lucie; Svoboda, Michal; Uher, Μ.; Křístková, Zlatuše; Vencovský, Jiří; Pavelka, Karel; Doležal, Tomáš

doi:10.1080/14712598.2020.1694900

Cited by 5 publications

(8 citation statements)

References 41 publications

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“…Patients with high ASDAS-CRP appeared to have higher disease activity at their follow-up visits despite anti-TNF treatment. Similar results were obtained in previous studies in which the immediate response to the first anti-TNF agent was shown to largely determine the long-term prognosis [14]. In addition, the anti-TNF agent retention rate was significantly lower in AS patients with high ASDAS-CRP results than among patients with low ASDAS-CRP results, although all would be considered to have low disease activity based on their BASDAI score.…”

Section: Discussionsupporting

confidence: 87%

“…Moreover, the ASDAS seems to better predict the patient prognosis than the BASDAI. One prospective study of 2274 AS patients newly treated with anti-TNF agents indicated that a low ASDAS-CRP (< 2.1) result after 3 months of anti-TNF treatment predicted the risk of future non-disability better than a low BASDAI (< 4) result and low CRP concentration (< 5 mg/L) [14]. A 12-year longitudinal study using data from the OASIS cohort revealed that models including the ASDAS-CRP as the disease activity measure fitted the data better than models including the BASDAI, CRP, or both the BASDAI and CRP.…”

Section: Discussionmentioning

confidence: 99%

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Low BASDAI score alone is not a good predictor of anti-tumor necrosis factor treatment efficacy in ankylosing spondylitis: a retrospective cohort study

Nam

Koo

Lee

et al. 2021

BMC Musculoskelet Disord

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Background The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who nonetheless have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Its clinical impact on anti-TNF survival was also investigated. Methods We conducted a single-centre retrospective cohort study of AS patients having low BASDAI scores (< 4) and available ASDAS-C-reactive protein (CRP) data after 3 months of first-line anti-TNF treatment. Patients were grouped into high-ASDAS (≥ 2.1) and low-ASDAS (< 2.1) groups according to the ASDAS-CRP after 3 months of anti-TNF treatment. Their characteristics were compared. And survival analyses were carried out using Kaplan–Meier curves and log-rank test with the event being discontinuation of anti-TNF treatment due to lack/loss of efficacy. Results Among 116 AS patients with low BASDAI scores after 3 months of anti-TNF treatment, 38.8% were grouped into the high-ASDAS group. The high-ASDAS group tended to have greater disease activity after 9 months of treatment (BASDAI 2.9 ± 1.1 vs. 2.3 ± 1.4, p=0.007; ASDAS-CRP 1.8 ± 0.6 vs. 1.5 ± 0.7, p=0.079; proportion of high ASDAS-CRP 27.8% vs. 13.8%, p=0.094) and greater risk of discontinuing anti-TNF treatment due to lack/loss of efficacy than the low-ASDAS group (p=0.011). Conclusions A relatively high proportion of AS patients with low BASDAI scores had high ASDAS-CRP. These low-BASDAI/high-ASDAS-CRP patients also had a greater risk for discontinuation of anti-TNF treatment due to low/lack of efficacy than the low-ASDAS group. The use of the ASDAS-CRP alone or in addition to the BASDAI may improve the assessment of AS patients treated with anti-TNF agents.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Low BASDAI score alone is not a good predictor of anti-tumor necrosis factor treatment efficacy in ankylosing spondylitis: a retrospective cohort study

Nam

Koo

Lee

et al. 2021

BMC Musculoskelet Disord

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“…Early studies demonstrated that younger age, male sex, HLA-B27 positivity, higher disease activity, increased CRP, and higher functional status were independent baseline predictors of the clinical response to TNFi treatment [ 14 , 16 , 17 ]. Subsequent studies showed that early response to TNFi predicted long-term clinical improvement [ 12 , 13 , 15 ], and the effect of baseline characteristics on the long-term clinical improvement was relatively small compared with the effect of early clinical response [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have evaluated the therapeutic effects of TNFi in patients with AS. Several studies that assessed predictors of clinical outcome in AS patients treated with TNFi used ASDAS-ID as the treatment target [ 12 , 13 , 14 , 15 ], and a few studies used low BASDAI with normal CRP as the target [ 13 ]. Although earlier studies identified only baseline clinical parameters as predictors for clinical remission [ 14 , 16 , 17 ], subsequent studies reported early clinical response as predictors of treatment outcome [ 12 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Early Improvements in Disease Activity Indices Predict Long-Term Clinical Remission Suggested by the Treat-to-Target Strategy in Patients with Ankylosing Spondylitis Receiving TNF-α Inhibitor Treatment

Nam

Lee

2021

JCM

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This study evaluated the possibility of clinical remission suggested by the treat-to-target strategy and identified predictors of clinical remission in 139 patients with ankylosing spondylitis (AS) receiving tumor necrosis factor-α inhibitors (TNFi). Clinical remission criteria selected were AS Disease Activity Score Inactive Disease (ASDAS-ID) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) < 2 with normal C-reactive protein (CRP) levels (BASDAI-CRP). The longitudinal relationship between clinical parameters and clinical remission was assessed using generalized estimating equations (GEEs). Responders to ASDAS-ID and BASDAI-CRP increased from 32.4% to 68.9% and from 39.9% to 75.2% at months 3 and 33, respectively. Responders to ASDAS-ID and BASDAI-CRP almost overlapped. In the univariable GEE model, age and 3-month improvement in BASDAI, ASDAS-CRP, physician and patient global assessments, and spinal pain predicted clinical remission achievement, while the presence of syndesmophytes predicted ASDAS-CRP achievement, and normalized CRP at 3 months was associated with BASDAI-CRP achievement. Multivariable GEE analysis revealed age (odds ratio (OR): 0.67; 95% confidence interval (CI), 0.49–0.93) and 3-month BASDAI improvement (OR: 1.70; CI, 1.19–2.41) as independent predictors of ASDAS-ID achievement and age (OR: 0.69; CI, 0.54–0.89), 3-month BASDAI improvement (OR: 2.00; CI, 1.45–2.76), and normalized CRP at 3 months (OR: 3.72; CI, 1.39–9.95) as independent predictors of BASDAI-CRP achievement.

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“…AS patients are also at risk of a broad range of extra-articular complications (uveitis, aortic regurgitation, fractures) and associated comorbidities (cardiovascular events, inflammatory bowel disease, psoriasis, and drug toxicity), which often occur later in the disease course and are not sufficiently addressed by short-term clinical trials [ 11 , 12 ]. Managing these complex features of AS thus poses a significant burden to the healthcare and public welfare systems through expenditures for medical care, disability support, and loss of productivity [ 13 ]. While there are emerging data that suggest long-term benefit of TNFi in improving mobility and lowering of cardiovascular risk [ 3 , 13 , 14 ], TNFi have also been associated with several serious side effects, including infections and malignancy [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

The Association Between TNF Inhibitor Therapy Availability and Hospital Admission Rates for Patients with Ankylosing Spondylitis. A Longitudinal Population-Based Study

et al. 2021

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Background TNF inhibiting drugs (TNFi) provide symptomatic relief for patients with ankylosing spondylitis (AS), but uncertainty remains about long-term benefits. We compared hospital admissions, emergency department (ED) presentations, and direct health care costs before and after the availability of subsidized TNFi therapy for AS patients. Methods State-specific dispensing and cost data for TNFi therapy for AS in Western Australia (WA) were obtained from Pharmaceutical Benefits Scheme (PBS) and expressed as the number of defined daily doses (DDD)/1000 population/day. Linked admission and ED data for 1783 AS patients followed for 14,257 person-years between 1990 and 2015 were extracted. Pre- and post-2005 admission rates/100,000 population were compared by rate ratio (RR). Results TNFi uptake in WA reached a DDD/1000 population/day 0.45 at an annual cost of AU$17.7 million in 2020. Hospital admission rates remained unchanged (RR: 0.95, CI 0.71–1.27, p = 0.66) but increased slightly in female patients (RR 1.22; CI 0.91–1.64, p = 0.20). While there was no change in cardiovascular admissions (6.3 vs. 6.2%, p = 0.6) or ED visit rates since 2005, frequency for cancer (2.7 vs. 3.8%, p < 0.01), infection (1.1 vs. 1.7%, p < 0.01) and mental health (4.0 vs. 4.5%, p < 0.02) admissions increased. Associated direct health care costs (2020 values) averaged AU$14.7 million before and AU$ 24.7 million per year after 2005. Conclusions The introduction of subsidized TNFi therapy did not change all-cause hospital admission or ED visit rates for existing AS patients. Whether the significantly increased direct health care costs are offset by reductions in other health care costs remains to be determined. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00393-x.

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Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry

Cited by 5 publications

References 41 publications

Low BASDAI score alone is not a good predictor of anti-tumor necrosis factor treatment efficacy in ankylosing spondylitis: a retrospective cohort study

Low BASDAI score alone is not a good predictor of anti-tumor necrosis factor treatment efficacy in ankylosing spondylitis: a retrospective cohort study

Early Improvements in Disease Activity Indices Predict Long-Term Clinical Remission Suggested by the Treat-to-Target Strategy in Patients with Ankylosing Spondylitis Receiving TNF-α Inhibitor Treatment

The Association Between TNF Inhibitor Therapy Availability and Hospital Admission Rates for Patients with Ankylosing Spondylitis. A Longitudinal Population-Based Study

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