Predictors of response to anti-TNF therapy in ankylosing spondylitis: results from the British Society for Rheumatology Biologics Register

Abstract

Objective. Few data exist on the use of anti-TNF drugs for AS during routine clinical use in the UK. This report describes an improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) after 6 months of therapy in 261 patients enrolled in a national prospective observational register.Methods. The British Society for Rheumatology Biologics Register (BSRBR) recruited patients starting anti-TNF therapy for AS between 2002 and 2006. Multivariable linear regression models were used to estimate the predictors of absolute improvement in BASDAI and BASFI at 6 months. Covariates included age, gender, disease duration, baseline BASDAI and BASFI, presence of raised inflammatory markers (defined as twice the upper limit of normal) and DMARD therapy.Results. The cohort was young (median age 43 years) and 82% were males. Median baseline BASDAI was 7.6 and BASFI 7.9. At 6 months, the mean improvements in BASDAI and BASFI were 3.6 and 2.6 U, respectively; 52% reached a BASDAI50. Patients with raised inflammatory markers at the start of therapy had a 0.9-U (95% CI 0.2, 1.5) better improvement in BASDAI compared with those without. Lesser responses were seen in those with higher baseline BASFI scores. Women had a 1.1-U (95% CI 0.3, 2.0) greater improvement in BASFI at 6 months, as did those who were receiving concurrent DMARD therapy [0.9 U (95% CI 0.2, 1.7)].Conclusions. The majority of patients receiving anti-TNF therapy for AS during routine care demonstrated an improvement in disease activity. Raised inflammatory markers at the start of therapy predicted a greater improvement in BASDAI, identifying a group of patients who may be more responsive to anti-TNF therapies, although the results were not confined to this group.

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

“…A systematic literature review showed that the use of MTX prolongs TNFi 23,24 . Interestingly, major response rates within the first year in our present cohort were high and comparable to those in previous studies 5,15,25,26 . To our knowledge, we are the first to report that clinical variables quantifiable early in the treatment course, such as ASDAS-CRP inactive disease state and DAS28-remission state, could predict a 2-to 3.5-fold higher chance of 10-year drug survival in everyday clinical practice.…”

Real Life Experience of First Course of Anti-TNF Treatment in Ankylosing Spondylitis Patients in Brazil

“…However, we could not confirm this supposition because we did not address the reasons for corticosteroid use in our study. The frequency of corticosteroid use among patients with AS has been found to be lower in other studies, ranging from 15 to 30% at the start anti-TNF therapy [5,6]. Thus, our results should raise awareness of the potential for the irrational prescribing and use of these drugs given the risks associated with their chronic use.…”

“…In contrast, the Danish Registry found a non-significant association with gender [15]. Fibromyalgia affects 15% of AS patients in a male:female ratio of 1:3, and its symptoms of morning stiffness, fatigue and pain can lead to a confounding effect in the disease activity response, whereas the variables of anti-TNF drug and disease duration did not reach statistical significance [6,15].…”

“…the British Society for Rheumatology Biologics Register reported a very similar outcome in 50% of patients [6].…”

Lessons from Genomic Profiling in AS

“…Data from the British Society of Rheumatology Biologics Register has shown raised inflammatory markers at the start of therapy predicted a greater improvement in disease activity, (Lord et al, 2010). Predictors of improvement in function, measured using the BASFI, have shown a strong association with gender (significantly greater improvement in women) and concurrent DMARDs therapy (Lord et al, 2010). Finally, prevention of damage is another important outcome of therapy.…”