Age has ‘positive impact’ on response to adalimumab for ankylosing spondylitis

Patients with ankylosing spondylitis who are younger, treated sooner after diagnosis and were exposed to fewer NSAIDs demonstrated an improved clinical response to adalimumab, according to findings presented at the American College of Rheumatology Annual Meeting.

Joachim Sieper, MD, of the Charité Universitätsmedizin Berlin, and colleagues conducted a phase 3, randomized, double-blind trial comparing the safety and efficacy of adalimumab vs. placebo among 301 patients with active ankylosing spondylitis treated unsuccessfully with NSAID therapy. Patients in the post hoc analysis were categorized according to baseline time since diagnosis (< 2 years vs. ≥ 2 years, < 5 years vs. ≥ 5 years and < 10 years vs. ≥ 10 years); age (< 35 years, 35-45 years and > 45 years); and number of prior NSAIDs (≤ 2 vs. > 2).

The researchers examined the effect of these factors on ankylosing spondylitis outcome measures at Week 12 among patients treated with at least one dose of adalimumab during the placebo-controlled period or open-label extension and prior NSAIDs at baseline.

Most patients (n = 205; 68.1%) received a diagnosis of ankylosing spondylitis 5 or more years earlier, were aged < 45 years (n = 182; 60.5%) and had been treated with ≤ two prior NSAIDs (n = 170; 56.5%). More men than women were noted across all subcategories.

Patients with less time between diagnosis and treatment were commonly younger; individuals with a longer disease duration since diagnosis were more often HLA-B27-positive. Levels of C-reactive protein were higher among patients treated with ≤ two previous NSAIDs, but baseline measures of disease activity were comparable across most categories.

At Week 12, a greater number of patients with less time since diagnosis, younger age and previous treatment with fewer NSAIDs had attained Assessment of Spondyloarthritis International Society (ASAS) 20 and ASAS40 responses and mean decreases in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores from baseline. The changes in clinical outcomes were significant between the < 35 and > 45 age groups (ASAS20, P < .001; ASAS40, P = .003; BASDAI, P = .002; BASFI: P = .012).

“Ankylosing spondylitis patients were found to respond better to tumor necrosis factor inhibitors if treated early in the disease course,” the researchers wrote. “The younger age (< 35 years) had the largest positive impact on the clinical outcomes as compared with higher age (> 45 years), suggesting its closest association with the actual disease duration. Overall, the results support the need for early effective treatment intervention in patients with ankylosing spondylitis to improve clinical outcomes.” – by Julia Ernst, MS

Reference:

Sieper J, et al. Abstract 735. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosures: Sieper reports associations with AbbVie, Merck, Pfizer and UCB. Please see the full study for a list of all other researchers’ relevant financial disclosures.