Study: Biologics improve AS, axSpA disease activity with insufficient improvement in fatigue
Patients with ankylosing spondylitis or non-radiographic axial spondyloarthritis demonstrated improvements in disease activity and fatigue after treatment with biologics, but severe fatigue remained in many patients, according to a recently published study.
Researchers studied 681 patients with ankylosing spondylitis (AS). Of this group, 66 patients had non-radiographic axial spondyloarthritis (nr-axSpA) and 489 patients were male with a median disease duration of 8 years. Almost half of the patients received tumor necrosis factor-alpha (TNF-) inhibitors, and 69.9% received NSAIDs.
Patients were evaluated using the Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS), Bath AS Functional Index (BASFI) score, modified Stokes AS Spinal Score (mSASSS), Fatigue Severity Scale (FSS), AS Quality of Life (ASQoL) questionnaire, EQ-5D20 health questionnaire, Medical Outcomes Study Short Form-36 (SF-36) and the Health Assessment Questionnaire (HAQ).
Patients with high fatigue scores were more likely to have enthesitis, arthritis, high C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR); higher total BASDAI and BASDAI inflammation, spinal pain, arthralgia and enthesitis; higher total BAFSI, HAQ, ASQoL and older age. Patients with low fatigue scores had higher scores on the EQ-5D20 and on the SF-36 mental and physical component subscales. No differences were observed for gender, disease duration, mSASSS scores, use of TNF- inhibitors or presence of anemia, uveitis or inflammatory bowel disease. Similar degrees of fatigue were observed between patients with AS and nr-axSpA.
Researchers discovered significant, but weak, correlations were observed between reported severe fatigue and enthesitis, arthritis, ESR and CRP. They also found a strong correlation between question 1 on the BASDAI and high FSS scores.
The strongest predictor of high fatigue was the HAQ, with an odds ratio (OR) of 5.6 for each increase in total HAQ score, followed by BASDAI inflammation and BASDAI enthesitis scores, each with an OR of 1.3 and 1.2, respectively, for each increased score unit.
The number of total patients with severe fatigue showed reductions in fatigue after treatment, but fatigue remained high in many patients, according to the researchers. The total BASDAI and BASDAI inflammation scores were lower overall after the initiation of TNF- inhibitors.
“[TNF- inhibition] therapy was associated with improvement in disease activity, and although this treatment led to significantly decreased fatigue scores, this reduction was not sufficient in the majority of patients, with 80% continuing to have severe fatigue according to their posttreatment scores,” the researchers wrote. – by Shirley Pulawski
Disclosure s : The researchers report no relevant financial disclosures.