Association between concomitant csDMARDs and clinical response to TNF inhibitors in overweight patients with axial spondyloarthritis

Hernández-Breijo, Borja; Plasencia-Rodríguez, Chamaida; Navarro-Compán, Victoria; Martínez‐Feito, Ana; Jochems, Andrea; Kneepkens, E.; Wolbink, Gertjan; Rispens, Theo; Diego, Cristina; Pascual‐Salcedo, Dora; Balsa, Alejandro

doi:10.1186/s13075-019-1849-3

Cited by 11 publications

(17 citation statements)

References 18 publications

(22 reference statements)

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“…The 11 studies included in the qualitative assessment were thoroughly examined to identify the type of publication (full text or conference abstract), design, number of participants, definition of population, exposure, and outcome (10,11,(24)(25)(26)(27)(28)(29)(30)(31)(32). The results of data extraction are shown in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta‐Analysis

Ortolan

Lorenzin

Felicetti

et al. 2021

Arthritis Care & Research

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The aim of our systematic review and meta-analysis was to investigate whether overweight/obesity are associated with higher disease activity measures in patients with axial spondyloarthritis (SpA).Methods. MEDLINE, PubMed, and Web of Science were searched using key terms corresponding to population (axial SpA patients), exposure (overweight/obesity), and outcome (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score [ASDAS]). Predefined inclusion criteria were adult patients with axial SpA, exposure classified according to body mass index (BMI), BASDAI/ASDAS reported for each BMI group, and observational studies. The Newcastle-Ottawa Scale for cohort, cross-sectional, and case-control studies was used for quality check. Random-effects meta-analysis was used to pool results, which were expressed as the mean difference (MD) in BASDAI and ASDAS between BMI groups, with 95% confidence intervals (95% CIs).Results. A total of 10 articles were included in the meta-analysis. The MD in BASDAI between normal BMI and overweight/obese patients was -0.38 (95% CI -0.56, -0.21; P < 0.0001); the MD in ASDAS between the same groups was -0.19 (95% CI -0.29, -0.09; P < 0.0001). The MD in BASDAI between normal BMI and overweight patients was -0.09 (95% CI -0.33, 0.15; P = 0.45), and the MD between normal BMI and obese patients was -0.78 (95% CI -1.07, -0.48; P < 0.0001). For ASDAS, the MD between normal BMI and overweight patients was -0.02 (95% CI -0.19, 0.15; P = 0.79), and the MD between normal BMI and obese patients was -0.42 (95% CI -0.60, -0.23; P < 0.0001).Conclusion. Overweight and obese patients with axial SpA tend to present higher disease activity scores compared to patients with a normal BMI. This difference seems to be clinically meaningful only for the comparison between obese patients and patients with normal BMI, and more for BASDAI than ASDAS.

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Section: Study Characteristicsmentioning

confidence: 99%

“…The designs of the included studies were longitudinal (n = 3), cross-sectional (n = 7), and case-control study (n = 1). The definition of the populations was rather heterogeneous, because some studies applied some treatment-based or comorbidity-based exclusion criteria to patients with axial SpA (Table 1) (10,11,24,26,30).…”

Section: Study Characteristicsmentioning

confidence: 99%

Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta‐Analysis

Ortolan

Lorenzin

Felicetti

et al. 2021

Arthritis Care & Research

View full text Add to dashboard Cite

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“…In addition, the development of immunogenicity increases drug clearance and is associated with low serum drug levels and consequently with lack of response (12). The concomitant use of csDMARDs like methotrexate (MTX) is also associated with the presence of serum drug, in part due the prevention of ADA formation (13)(14)(15). ASAS-EULAR advises against using csDMARDs to control axial disease in patients with axSpA (1); however, in clinical practice, csDMARDs are used for treating peripheral joint or extra-musculoskeletal manifestations (13) .…”

Section: Introductionmentioning

confidence: 99%

Early monitoring of infliximab serum trough levels predicts long-term therapy failure in patients with axial spondyloarthritis

Martínez‐Feito

Navarro-Compán

Hernández-Breijo

et al. 2021

Scandinavian Journal of Rheumatology

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Background: The aim of our study is to evaluate whether serum in iximab trough levels (ITL) during the early stages of treatment are predictive of long-term clinical failure in patients with axial spondyloarthritis (axSpA).Methods: Longitudinal observational study involving 81 patients with axSpA recruited from the SpA-Paz cohort and monitored during in iximab therapy. Serum ITL were measured at baseline, week 2 (W2), W6 and W12 of treatment. Disease activity was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) at baseline, W24 and W54, and every 6 months thereafter until therapy failure. Nonclinically important improvement was de ned by ΔASDAS<1.1. The association between serum ITL levels at W12 and clinical outcomes (non-improvement at W52, drug survival and drop-out due to secondary ine cacy) was investigated through logistic regression models and Kaplan Meier curves. Receiver operating characteristic (ROC) curves were employed to determine the best cut-off for serum ITL.Results: Out of the 81 patients, 45 (56%) did not achieve clinical improvement at W52. These patients had lower serum ITL at W12 compared to those who improved: ITL [median (IQR)]: 4.1(0.9-8.3) µg/ml vs 7.1(4.3-11.3)µg/ml, respectively; p=0.007). A cut-off of ITL<6.7µg/mL at W12 was signi cantly associated with: i) not achieving clinical improvement at W52 (OR: 2.3; 95%CI: 1.3-3.9); ii) shorter drug survival (5.0 years (95% CI: 3.8-6.2) vs 7.6 years (95% CI: 4.8-6.9); p=0.04); and iii) higher drop-out rates due to secondary ine cacy (OR: 3.5; 95%CI: 1.2-10.2).Conclusions: Serum ITL<6.7 µg/mL at W12 were associated with long-term clinical failure in patients with axSpA, especially due to secondary ine cacy.

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“…Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) have been used with some success to treat peripheral arthritis in SpA patients; however, they have not clearly demonstrated efficacy for the treatment of enthesitis or the axial manifestations of axSpA [ 15 – 17 ]. In contrast, tumor necrosis factor inhibitors (TNFi’s) have been shown to be effective in improving or resolving enthesitis in clinical trials in patients with axSpA [ 18 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors

et al. 2021

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Background Enthesitis is a hallmark of spondyloarthritis (SpA) with a substantial impact on quality of life. Reports of treatment effectiveness across individual enthesitis sites in real-world patients with axial SpA (axSpA) are limited. We investigated the evolution of enthesitis following tumor necrosis factor inhibitor (TNFi) initiation in axSpA patients, both cumulatively and at specific axial and peripheral sites. Methods AxSpA patients in the Swiss Clinical Quality Management Registry were included if they initiated a TNFi, had an available Maastricht Ankylosing Spondylitis Enthesitis Score, modified to include the plantar fascia (mMASES, 0–15), at start of treatment and after 6 and/or 12 months and ≥12 months follow-up. Logistic regression models were utilized to analyze explanatory variables for enthesitis resolution. Results Overall, 1668 TNFi treatment courses (TCs) were included, of which 1117 (67%) had active enthesitis at baseline. Reduction in mMASES at the 6- and 12-month timepoints was experienced in 72% and 70% of TCs, respectively. Enthesitis resolution at 6/12 months occurred in 37.9%/43.0% of all TNFi TCs and 40.7%/50.9% of first TNFi TCs. At 6 months, a significant reduction in the frequency of enthesitis was observed at all sites, except for the Achilles tendon and plantar fascia among first TNFi TCs, while at 12 months, reduction was significant at all sites in both TC groups. Enthesitis resolved in 60.3–77% across anatomical sites, while new incident enthesitis occurred in 4.0–13.5% of all TNFi TCs at 12 months. Both baseline and new-incident enthesitis occurred most frequently at the posterior superior iliac spine and the fifth lumbar spinous process. Younger age and lower mMASES at baseline were predictors of complete enthesitis resolution, while female sex and second- or later-line TNFi treatment were associated with persistence of enthesitis at 12 months. Conclusion In real-world axSpA patients treated with a TNFi, enthesitis improved in the majority of patients across all anatomical sites. Significant improvement at the Achilles and plantar fascia entheses was observed only at 12 months. Complete and site-specific enthesitis resolution occurred in ≥40% and ≥60% of TCs evaluated at 12 months, with a low incidence of new site-specific enthesitis. Trial registration Not applicable.

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Association between concomitant csDMARDs and clinical response to TNF inhibitors in overweight patients with axial spondyloarthritis

Cited by 11 publications

References 18 publications

Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta‐Analysis

Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta‐Analysis

Early monitoring of infliximab serum trough levels predicts long-term therapy failure in patients with axial spondyloarthritis

Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors

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