Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis—findings from a United Kingdom cohort

Yahya, Fariz; Gaffney, Karl; Hamilton, Louise; Lonsdale, Ellie; Leeder, Jane; Brooksby, A; Cavill, Charlotte; Berry-Jenkins, Joshua; Boyle, Cathal; Bond, Debbie; Sengupta, Raj; BRITSpA, for

doi:10.1093/rheumatology/kex457

Cited by 30 publications

(28 citation statements)

References 17 publications

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“…The efficacy rates of subsequent bDMARDs are generally reduced, as shown in the Danish DANBIO registry, where the mean reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at 6 months was 3 units for the index bDMARD, compared to 1.5 BASDAI units for the 3rd bDMARD [65]. Drug survival for sequential bDMARDs also follows a similar pattern with one study reporting the mean drug survival for the index bDMARD being 10.2 years compared to 5.5 years for the second [66]. The best switching strategy for biologics in axSpA remains unclear, with no randomised trials to inform this decision.…”

Section: Therapy In Nr-axspamentioning

confidence: 73%

Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in Classification, Imaging and Therapy

2019

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Non-radiographic axial spondyloarthritis (nr-axSpA) is a recently described form of axial inflammatory arthritis that has not caused substantial erosive damage to the sacroiliac joints. Nr-axSpA is associated with significant impairment in quality of life and, in a proportion of patients, it can evolve into ankylosing spondylitis (AS, also termed radiographic axSpA). The identification in the clinic of nr-axSpA has been made possible by advances in magnetic resonance imaging (MRI). Classification criteria for nr-axSpA have been proposed but there remains discussion in the international community regarding this. Studies are ongoing to further define the classification and diagnosis of nr-axSpA. There is much further research required regarding the optimal use of MRI in nr-axSpA, including distinguishing sacroiliac MRI changes in the normal population and the definition of a positive MRI in spinal disease. Non-steroidal anti-inflammatory drugs and physiotherapy are the core first-line therapy for nr-axSpA. Tumour necrosis factor inhibitors also play a very important role in treatment of patients with active nr-axSpA who do not respond to first-line therapy. Agents directed at interleukin-17, interleukin-23 and Janus kinase inhibitors are proving effective in AS with ongoing and planned studies in nr-axSpA. A great deal of active research is being undertaken in classification, imaging and therapy in nr-axSpA and so the future for improving the lives of patients with nr-axSpA is promising.

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Section: Therapy In Nr-axspamentioning

confidence: 73%

Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in Classification, Imaging and Therapy

2019

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“…Studies that have reported that axSpA-specific factors predict response to TNFα have generally not collected information on socio-economic factors and may therefore have been affected by unmeasured confounding [e.g. 31 , 32 ]…”

Section: Discussionmentioning

confidence: 99%

Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS

et al. 2020

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Objectives While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit. Methods The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the ‘biologic’ sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state. Results 335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12–17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%). Conclusion Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.

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“…Recently, results from a two-center cohort of AS patients treated with TNFi (ADA: n= 332, etanercept: n = 205, IFX: n = 51, golimumab: n = 40, and CZP: n = 23) in the United Kingdom have been published. 45 Median drug survival duration for first TNFi was 10.2 years, which was superior to second TNFi (5.5 years) ( P < 0.05). No drug-specific ( P = 0.45) differences were observed for TNFi survival, although follow-up for patients with CZP was shorter.…”

Section: Introductionmentioning

confidence: 88%

“…No drug-specific ( P = 0.45) differences were observed for TNFi survival, although follow-up for patients with CZP was shorter. 45 …”

Section: Introductionmentioning

confidence: 99%

Spotlight on certolizumab pegol in the treatment of axial spondyloarthritis: efficacy, safety and place in therapy

Marín

Felquer

Soriano

2018

OARRR

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Certolizumab pegol (CZP) is a pegylated humanized tumor necrosis factor-α inhibitor (TNFi) approved for the treatment of ankylosing spondylitis (AS) in the USA and for AS and non-radiographic axial spondyloarthritis (nr-axSpA) in Europe and in some Latin American countries. CZP lacks Fc region, preventing complement fixation and cytotoxicity mediated by antibody; CZP does not actively cross the placenta, unlike other TNFi. RAPID-axSpA study is a Phase III trial conducted in patients with AS and nr-axSpA as double blind and placebo controlled to week 24, dose blind to week 48 and open label to week 204. Of a total of 325 patients recruited, 107 patients were assigned to placebo and 218 patients to CZP (111 to CZP 200 mg Q2W, 107 to CZP 400 mg Q4W). Improvements in axial involvement, joint involvement, enthesitis and quality of life were reported in patients treated with CZP. Safety profile was like that reported for other TNFi in axSpA patients. In this article, we summarized the pharmacology and we reviewed the efficacy and tolerability of this drug for the treatment of axSpA. Some special considerations of CZP during pregnancy are included. CZP, the latest TNFi to be approved, showed efficacy in all manifestations of AS and nr-axSpA.

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Tumour necrosis factor inhibitor survival and predictors of response in axial spondyloarthritis—findings from a United Kingdom cohort

Cited by 30 publications

References 17 publications

Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in Classification, Imaging and Therapy

Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in Classification, Imaging and Therapy

Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS

Spotlight on certolizumab pegol in the treatment of axial spondyloarthritis: efficacy, safety and place in therapy

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