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Shorter disease duration correlated with improved axial spondylarthritis after anti-TNF therapy
Patients with axial spondylarthritis treated with tumor necrosis factor inhibitors showed a better correlation with improvement in inflammation in the first 4 years of disease compared with longer disease duration, according to recent study results.
Researchers in Berlin pooled and analyzed data from 112 patients with axial spondylarthritis (SpA) who were originally enrolled in two randomized controlled trials after 1 year of treatment with etanercept (n=66) or adalimumab (n=46). Improvements in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Disease Activity Score (ASDAS), C-reactive protein (CRP) and magnetic resonance imaging score for sacroiliac joints (SIJ) were compared between patients with less than 4 years of disease (n=58; mean age, 31.7 years; 51.7% men) and those with at least 4 years of disease (n-54; mean age, 37.8 years; 51.9% men).
Significantly better improvement for patients with shorter disease vs. those with greater duration was shown in BASDAI (3.2; 95% CI, 2.7-3.7 vs. 1.7; 95% CI, 1.1-2.2), BASFI (2.4; 95% CI, 2-2.9 vs. 1.2; 95% CI, 0.7-1.6), BASMI (0.3; 95% CI, 0-0.6 vs. –0.1; 95% CI, –0.4 to 0.2) and ASDAS (1.6; 95% CI, 1.4-1.8 vs. 0.9; 95% CI, 0.7-1.1).
In subgroup analysis for patients with short disease duration, BASDAI change correlated with changes in SIJ score (rho=0.37; P=.01) and CRP values (rho=0.52; P=.005). The correlation was poor and did not reach statistical significance in patients with long disease duration.
“The low correlation between change of [patient reported outcomes] and change of objective signs of inflammation seen in axial SpA patients with longer symptom duration treated with tumor necrosis factor-blocker seems to indicate that inflammation is not the only cause of the patients’ symptoms, while inflammation seems to be the major cause in short diseased patients,” the researchers concluded.
Disclosure: See the study for a full list of relevant financial disclosures.