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TNF-alpha inhibitors equally potent in treatment of AS, sulfasalazine improves continuation
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A comparative study of patients with ankylosing spondylitis treated with a first-time and then a second tumor necrosis factor-alpha inhibitor showed treatments were equally effective. Findings also indicated patients were more likely to continue certain treatments, and the concomitant use of sulfasalazine improved the odds for continuation.
Researchers retrospectively studied data from 875 patients with ankylosing spondylitis (AS) in the National Register for Biologic Treatment in Finland, and identified 543 patients who received a first-time biologic and 123 patients who began a second biologic medication for study inclusion. The median disease duration was 7.7 years and 62% of patients were men. The median Bath AS Disease Activity Index (BASDAI) score was 5.8 and the median AS Disease Activity Score (ASDAS) was 3.3.
Humira (adalimumab; AbbVie), Enbrel (etanercept; Amgen) or Remicade (infliximab; Janssen) was received by 29%, 48% and 23% of patients, respectively, as a first biologic and by 59%, 33% and 8%, respectively, as a second-attempt biologic therapy. Twenty-five patients received a biologic treatment other than adalimumab, etanercept or infliximab. The most commonly prescribed concomitant, conventional, disease-modifying anti-rheumatic drugs (cDMARDs) were methotrexate (49%) and sulfasalazine (45%), and 78% of patients who began a first biologic received cDMARDs compared with 67% of patients who received a second biologic.
At 6 months, 26% of first-time biologic recipients were lost to follow-up. At 12 months, 32% of patients were lost to follow-up. At 24 months, 37% of patients were lost to follow-up.
A BASDAI response was achieved by 52% of first-time patients at 6 months and by 25% of patients who received a second biologic, including 57% of patients who received etanercept, 47% of patients who received adalimumab and 49% of patients who received infliximab. A clinically meaningful ASDAS response was observed in 52% of first-time biologic recipients and by 25% of second-line recipients.
No differences in treatment efficacy of with the concomitant use of a cDMARD were seen in adjusted logistical regression analyses. The year of treatment onset and baseline BASDAI scores were associated with a positive response to treatment, and the use of etanercept compared to younger age or use of infliximab was predictive of BASDAI response.
At 6 months, 12 months and 24 months, 8%, 16% and 25% of patients who received a first-time biologic discontinued therapy, respectively. At 24 months, 28% of patients who attempted a second biologic discontinued treatment.
Drug survival was improved in patients who received etanercept or adalimumab, according to results of multivariate analyses. Investigators also found concurrent use of sulfasalazine, male sex, longer time from diagnosis and lower baseline Bath AS Functional Index were predictive of increased drug survival. – by Shirley Pulawski
Disclosures: The researchers report no relevant financial disclosures.
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