Challenges and Advances in Targeting Remission in Axial Spondyloarthritis

Baraliakos, Xenofon; Bérenbaum, Francis; Favalli, Ennio Giulio; Olivieri, Ignazio; Ostendorf, Benedikt; Poddubnyy, Denis; Vlam, Kurt de

doi:10.3899/jrheum.170222

Cited by 11 publications

(7 citation statements)

References 39 publications

(45 reference statements)

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“…Considering that patients with TNFi treatment for less than 1 year were excluded, the possibility of achieving the target could be lower in real-world settings [20, 21]. The finding is also consistent with the results of previous randomized controlled trials where the probability of achieving ASDAS-ID with TNFi treatment ranged between 16.1 and 36.5% [5, 22–24]. In contrast, BASDAI50 criteria were fulfilled in approximately 80% of the intervals, indicating that it is a more lenient target than ASDAS-ID.…”

Section: Discussionsupporting

confidence: 84%

Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study

et al. 2019

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Objectives To investigate the association between the extent of tapering tumor necrosis factor inhibitor (TNFi) and the likelihood of achieving inactive disease in patients with axial spondyloarthritis (axSpA) Methods We analyzed 1575 1-year follow-up interval data of 776 axSpA patients treated with TNFi for more than 1 year in a nationwide observational cohort. The decision on tapering TNFi was made by patients and their physicians. We quantified TNFi used during interval as a dose quotient (DQ). The intervals were classified into the heavy-tapering (DQ < 50), mild-tapering (DQ 50–99), and control groups (DQ = 100). Outcome variables included achieving Ankylosing Spondylitis Disease Activity Score-inactive disease (ASDAS-ID) and major clinical response of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) in the follow-up visit. The effects of TNFi tapering on the outcome were analyzed using the generalized estimating equation. Results At the baseline visit, 91.1% of the patients showed a high disease activity (ASDAS-CRP ≥ 2.1). DQ of each interval was significantly influenced by the ASDAS-CRP measure in the prior follow-up ( P < 0.001). ASDAS-ID was observed in 42.3% of the intervals. A multivariable analysis showed that the likelihood of outcome achievement was comparable between the control and mild-tapering groups, but significantly decreased in the heavy-tapering group (vs. the control group, adjusted OR = 0.28, [95% CI, 0.08–0.94]). In contrast, the likelihood to achieve BASDAI50 response was not different among the groups. In the subgroup of patients who reached ASDAS-ID 1 year after TNFi treatment ( n = 327), ASDAS-ID was observed in 66.1% of the subsequent intervals, and only the mild-tapering group showed a likelihood of target maintenance comparable with that of the control group (adjusted OR = 1.25 [0.41–3.80]). This likelihood decreased with an increase in ASDAS-CRP. Conclusion Mild tapering of TNFi has efficacy comparable with that of the standard-dose treatment for ASDAS-ID achievement in patients with axSpA. Electronic supplementary material The online version of this article (10.1186/s13075-019-1943-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 84%

Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study

et al. 2019

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“…Although an internal task force has recommended a T2T strategy, with ASDAS as the suggested tool for the management of axSpA [4], a lack of evidence from RCTs for the added value of a T2T strategy in axSpA and the lack of universally accepted remission criteria are major barriers to the implementation of a T2T approach in axSpA [7][8][9]. Recently, ASDAS-ID (score \ 1.3) has been recommended as a preferred measure for remission in AS since it is a composite index with validated cutoffs, including an objective marker of inflammation (C-reactive protein) [4,34].…”

Section: Discussionmentioning

confidence: 99%

“…Shift analysis on ASDAS status from week 16 to 156 included the following ASDAS disease activity states based on validated criteria: very high disease activity (VHDA), [ 3.5; high disease activity 2.1-to 3.5; LDA, 1.3 to \ 2.1; and ID, \ 1.3 [26,33]. Sustainability of ASAS-PR at the individual patient level was assessed between week 16 and weeks 104 and 156 [7]. Shift analysis on BASDAI states from week 16 to 156 was based on following (non-validated) threshold criteria (C 4, C 3 to \ 4, [ 2 to \ 3, and B 2).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…An international task force recommended that a treat-to-target (T2T) strategy should be the standard treatment approach in axSpA, with clinical remission, ID, or LDA as the desired response or target for physicians and patients [4]. However, the lack of evidence from randomized controlled trials (RCTs) and of universally accepted remission criteria are major barriers to the implementation of a T2T approach in axSpA [7][8][9].…”

Section: Digital Features Introductionmentioning

confidence: 99%

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Achievement of Remission Endpoints with Secukinumab Over 3 Years in Active Ankylosing Spondylitis: Pooled Analysis of Two Phase 3 Studies

et al. 2020

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Introduction Clinical remission in patients with ankylosing spondylitis (AS) has been determined using composite indices such as the AS Disease Activity Score inactive disease (ASDAS-ID), Assessment of SpondyloArthritis international Society criteria partial remission (ASAS-PR), and low Bath AS Disease Activity Index (BASDAI) scores. The objective of this exploratory analysis was to evaluate the proportion of secukinumab-treated patients with AS achieving remission defined based on the ASDAS-ID (score < 1.3), ASAS-PR or BASDAI score ≤ 2. Methods The analysis pooled data from the MEASURE 1 and 2 studies over 3 years. The proportion of patients who achieved ASDAS-ID, ASAS-PR, or BASDAI ≤ 2 with secukinumab was compared with placebo at week 16; results for secukinumab-treated patients were summarized through week 156. Sustainability of each criterion was assessed from week 16 to 156 using shift analysis. The association between each of these criteria and specific patient-reported outcomes (PROs), such as health-related quality of life, function, fatigue, and work impairment, was also explored. Results At week 16, a higher proportion of secukinumab-treated patients versus placebo achieved ASDAS-ID (17.6 vs. 3.5%), ASAS-PR (15.4 vs. 4.1%), or BASDAI ≤ 2 (22.3 vs. 6.4%) criteria (all P < 0.0001), which were sustained through 156 weeks. Shift analysis showed that the majority of secukinumab-treated patients achieving remission at week 16 maintained their status at week 156 (ASDAS-ID, 57.1%; ASAS-PR, 68.0% and BASDAI ≤ 2, 74.3%). Remission was also associated with improved PROs over 156 weeks. Conclusions Secukinumab-treated patients maintained ASDAS-ID, ASAS-PR, or BASDAI ≤ 2 from week 16 up to 3 years. Patients who achieved at least one of the three responses/states, reported improvement in PROs, which suggests an association of clinical remission/ID with PROs in patients with active AS. Trial registration ClinicalTrials.gov: NCT01358175, NCT01863732, and NCT01649375 Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00269-6.

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“… 7 On the other hand, an active discussion of experts is ongoing in both PsA and AxSpA - multifaceted diseases with different manifestations - including the natural course in each individual patient. 2 , 8 Of note, the recent guidelines and recommendations of the American College of Rheumatology, in collaboration with the National Psoriasis Foundation for the Treatment of Psoriatic Arthritis and the Spondylitis Association of America/Spondyloarthritis Research and Treatment Network for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis, indicate a different approach. 9 , 10 The conditional recommendation for PsA is to use a treat-to-target strategy without a clear proposal for a specific index-based target, indicating that a patient-doctor discussion may define it individually.…”

Section: Introductionmentioning

confidence: 99%

Treating to Target in Clinical Practice: The Results of a Questionnaire Completed by Greek Rheumatologists

Karatsourakis¹,

Baraliakos

2020

MJR

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Background: The Treat-To-Target (TTT) approach is an important part of clinical practice in rheumatology. Although this approach is well structured in rheumatoid arthritis (RA) and data are accumulating in psoriatic arthritis (PsA) and axial spondyloarthritides (AxSpA), the systematic application of this process in clinical practice can be further improved to achieve better treatment outcomes. Objective: The aim of this study was to present the perspective of clinical rheumatologists on how they evaluate disease activity, in what patient groups they regularly use treatment targets, and how they prioritize treatment targets in spondyloarthritides. Methods: A questionnaire consisting of eight questions on the management of RA, PsA and AxSpA (4 focusing on the use of indexes when setting treatment targets, 2 on the frequency and the patient groups to which these are being applied, and 2 on the physician’s priorities in managing different manifestations of the SpA spectrum) was completed by private practice and hospital-based rheumatologists. Results: 160 rheumatologists completed the questionnaire. The majority use the formal composite indexes in clinical practice, certain items from these indexes, and patients’ evaluation of the treatment intervention. Indexes are applied frequently in most patient groups, and the priorities of rheumatologists include both musculoskeletal manifestations, as well as the other clinical aspects of the SpA spectrum. Conclusion: The results can contribute to the understanding of the adherence of rheumatologists to this TTT strategy.

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Challenges and Advances in Targeting Remission in Axial Spondyloarthritis

Cited by 11 publications

References 39 publications

Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study

Effects of tapering tumor necrosis factor inhibitor on the achievement of inactive disease in patients with axial spondyloarthritis: a nationwide cohort study

Achievement of Remission Endpoints with Secukinumab Over 3 Years in Active Ankylosing Spondylitis: Pooled Analysis of Two Phase 3 Studies

Treating to Target in Clinical Practice: The Results of a Questionnaire Completed by Greek Rheumatologists

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