Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis registry

Abstract

Objectives To describe the baseline characteristics, bDMARD response and drug survival of axSpA patients in the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) according to radiographic status. Methods BSRBR-AS is a national prospective cohort including axSpA participants classified according to the ASAS criteria. In this analysis, baseline data of patients starting bDMARDs were compared. Ankylosing Spondylitis Disease Activity Scores (ASDAS) for low disease status, clinically important improvement (CII) and major improvement (MI) at one year were used to assess treatment response. Cox proportional hazard analysis was performed after adjusting for clinically relevant cofounders. Results 1,145 axSpA patients were included. Higher male prevalence, older age and longer disease duration was seen in the r-axSpA subgroup. Based on a complete case analysis (290 patients), two thirds of patients achieved ASDAS low disease state at one year regardless of radiographic status (nr-axSpA: 64.2% vs r-axSpA: 66.1). No statistically significant differences were seen between the subgroups in attaining ASDAS CII (nr-axSpA: 50.7% vs r-axSpA: 44.7%) or MI (nr-axSpA: 20% vs r-axSpA: 18.7%). Drug survival probability curves were similar for both subgroups and hazard ratio for nr-axSpA/axSpA was 0.94 (95% CI 0.69-1.28) when adjusted for sex, age, baseline ASDAS-CRP, smoking status, disease duration, HLA-B27 and prescribed biologic. Conclusions Although there appeared to be some differences in the baseline characteristics when exploring this cohort according to radiographic status which are likely related to the natural history of the disease, the level of biologic response and drug survival was comparable between nr-axSpA and r-axSpA.

Non‐radiographic axial spondyloarthritis in South America. Burden of disease and differential features with respect to ankylosing spondylitis at time of diagnosis. A comprehensive analysis with a focus on images

“…In other cohorts, significant differences are also usually observed in relation to biological treatment, which is usually lower in patients with nr-axSpA vs AS despite having the same disease burden. 22 In the present study, we have only noticed a trend towards a higher percentage of biological treatment in patients with AS vs nr-axSpA, this being non-significant.…”

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

“…In our cohort, three out of four patients achieved momentary R/LDA in at least 1 of the visits after 2 years of follow-up, as measured both by ASDAS and BASDAI&CRP. Compared with previous research, a recent analysis by the British Society for Rheumatology Biologics Register in AS (BSRBR-AS) showed that two-thirds of axSpA patients achieved an ASDAS LDA at 1 year 11. A study that drew from 12 European registries and that included 24 195 European axSpA patients initiating a first TNFi demonstrated that 27% of patients achieved ASDAS remission after 6 months, while 59% achieved BASDAI LDA.…”

“…Compared with previous research, a recent analysis by the British Society for Rheumatology Biologics Register in AS (BSRBR-AS) showed that two-thirds of axSpA patients achieved an ASDAS LDA at 1 year. 11 A study that drew from 12 European registries and that included 24 195 European axSpA patients initiating a first TNFi demonstrated that 27% of patients achieved ASDAS remission after 6 months, while 59% achieved BASDAI LDA. Crude response rates for both indices progressively increased at 12 and 24 months.…”

Current differentiation between radiographic and non-radiographic axial spondyloarthritis is of limited benefit for prediction of important clinical outcomes: data from a large, prospective, observational cohort

“…15 The latter seems of particular relevance as patients with nr-axSpA and r-axSpA have been shown to present with a comparable disease burden 16 and to respond similarly well to treatment with biologics when objective signs of inflammation are taken into consideration. [17][18][19][20][21][22][23] Moreover, significant progress has been made over the past decade to improve identification of both inflammatory and structural SIJ changes on MRI, allowing not only for earlier diagnosis, but also for improved differentiation from alternative reasons of back pain. [24][25][26][27] However, MRI is currently used in RCTs only for purposes of disease classification.…”

“…Consequently, it has been suggested to abandon the distinction between nr-axSpA and r-axSpA and that RCTs should be performed across the whole spectrum of axSpA 15. The latter seems of particular relevance as patients with nr-axSpA and r-axSpA have been shown to present with a comparable disease burden16 and to respond similarly well to treatment with biologics when objective signs of inflammation are taken into consideration 17–23. Moreover, significant progress has been made over the past decade to improve identification of both inflammatory and structural SIJ changes on MRI, allowing not only for earlier diagnosis, but also for improved differentiation from alternative reasons of back pain 24–27.…”