Achievement rate and predictive factors of the recommended therapeutical target in patients with axial spondyloarthritis who remain on biological therapy: a prospective cohort study in Spain

Abstract

ObjectivesTo determine the frequency of sustained remission (R) or low diseas activity (LDA) in patients with axial spondyloarthritis (axSpA) undergoing long-term biological therapy and to analyse predictive factors for achieving these outcomes.DesignProspective, observational cohort study.SettingSpanish hospital.ParticipantsPatients with axSpA who initiated biological treatment between 2003 and 2017.InterventionAssessment of demographic and clinical characteristics at the beginning of treatment and disease activity every 6 months up to a maximum of 2 years.Main outcome measuresDisease activity was measured by Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index and C reactive protein (BASDAI&CRP). Sustained R was defined as ASDAS<1.3 and/or BASDAI <2 and normal CRP while sustained LDA was defined as ASDAS <2.1 and/or BASDAI <4 and normal CRP on at least three consecutive visits.ResultsIn total 186 patients (66.1% men and 75.3% with radiographic sacroiliitis) were included. Overall, 76.8% of patients achieved ASDAS R/LDA (R53.2%/LDA23.6%) in at least one visit. Forty per cent (R17.6%/LDA22.4%) of the patients fulfilled the sustained ASDAS R/LDA state, whereas only 30.8% maintained this status (R14.8%/LDA15.9%) according to BASDAI&CRP. In the multivariate analysis, male sex (OR=4.01), younger age at the beginning of biological therapy (OR=0.96) and an HLA*B27 positive status (OR=4.30) were associated with achieving sustained ASDAS R/LDA.ConclusionsIn clinical practice, around one-third of patients on biological disease-modifying antirheumatic drugs achieve a sustained R/LDA status, but these rates drop to less than one in five when targeting remission, preventing the use of the latter as a feasible target. Male sex, HLA*B27 positivity and younger age at the beginning of biological therapy are the main predictors for achieving sustained R/LDA.

Difficult-to-treat axial spondyloarthritis is associated with psoriasis, peripheral involvement and comorbidities: results of an observational nationwide study

“…For example, in a Spanish prospective cohort, one-third of patients on biological therapy for axSpA achieved a low activity status over 18 months, and less than 20% achieved remission. 5 In a report from the Scandinavian registries, analysis of targeted therapy switches in more than 6000 patients revealed that 8%, 3% and 1% of patients received at least three, four or five targeted therapies, respectively, during the 3 years of follow-up. There was no relationship between the number of rotations and calendar period.…”

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

“…Axial spondyloarthritis patients with positive HLA-B27 status seem to respond better to therapy. In a Spanish prospective observational cohort of 186 axSpA patients who initiated biological treatment between 2003 and 2017, HLA-B27 positive status was associated with achieving a state of remission or low disease activity (OR 4.30 95% CI 1.68–11.01) [91 ▪ ].…”

Patients with radiographic axial spondylarthritis have an impaired dietary intake—a cross-sectional study with matched controls from northern Sweden

“…The implementation of biological disease-modifying anti-rheumatic drugs (bDMARDs) has also revolutionized the pharmacological treatment options, when non-steroidal anti-inflammatory drugs (NSAID) and physiotherapy are not sufficient. Nevertheless, maintained remission over time is uncommon [ 3 ], and a large proportion of patients with r-axSpA still experience residual pain, stiffness, a deteriorated physical capacity, and reduced health-related quality of life [ 4 ]. Patients with SpA themselves often experiment with different dietary regimens in the hope of alleviating their symptoms or to reach prolonged remission [ 5 , 6 ].…”