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TNFi effectiveness: nonradiographic axial spondyloarthritis vs ankylosing spondylitis

27 Jan 2017

Subjective disease activity is higher in patients with nonradiographic axial spondyloarthritis (nr-axSpA) at start of tumour necrosis factor inhibitor (TNFi) treatment, but outcomes are similar to patients with ankylosing spondylitis (AS) after adjusting for confounders, according to a nationwide cohort study.

In addition, HLA-B27 positivity is associated with better outcomes regardless of axSpA subdiagnosis.

Researchers conducted an observational cohort study based on data from the nationwide DANBIO registry to compare baseline disease activity and treatment effectiveness in biologic-naïve patients with nr-axSpA and AS who started TNFi treatment, as well as to analyse the role of potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity).

Kaplan-Meier plots, Cox and logistic regression analyses were used to assess the effect of diagnosis (nr-axSpA vs AS) and potential confounders on TNFi adherence and response (eg, Bath Ankylosing Spondylitis Activity Index [BASDAI] 50 percent/20 mm).

At TNFi initiation, nr-axSpA patients had higher visual analogue scale scores, compared with AS patients, for pain (median 72 vs 65 mm), global (76 vs 68 mm), fatigue (74 vs 67 mm) and BASDAI (64 vs 59; p<0.01 for all). Patients with nr-axSpA, however, had lower C-reactive protein (7 vs 11 mg) and BAS Metrology Index (20 vs 40; p<0.01 for all).

Median treatment adherence was poorer in nr-axSpA than in AS patients (1.59 years; 95 percent CI, 1.15 to 2.02 vs 3.67 years; 2.86 to 4.49; p<0.0001) in univariate analysis, but not in confounder-adjusted analysis (p>0.05). Both nr-axSpA and AS groups had similar response rates (p>0.05).

HLA-B27 negativity correlated with poorer treatment adherence (HLA-B27 negative/positive, nr-axSpA: hazard ratio [HR], 1.74; 1.29 to 2.36; AS: HR, 2.04; 1.53 to 2.71; p<0.0001 for both) and lower response rates (nr-axSpA: 30 vs 55 percent; AS: 29 vs 54 percent; both p<0.05).

A total of 1,250 TNFi-naïve patients with axSpA were included in the study. Patients with nr-axSpA were more frequently women (50/27 percent) and HLA-B27–negative (25 percent), compared to AS (17 percent; p<0.01).

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Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

3 days ago
A recent study suggests that discontinuation of dexamethasone premedication after two uneventful infusions or reduction in the dose of dexamethasone paclitaxel premedication are both safe alternatives to high-dose steroid premedications recommended in product labelling.
01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute.