TNF inhibitors equally safe, effective in young- and late-onset ankylosing spondylitis
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Key takeaways:
- There were “no significant differences” in efficacy, safety or adherence for TNF inhibitors between young- and late-onset ankylosing spondylitis.
- Management of late-onset ankylosing spondylitis can be similar to young-onset.
TNF inhibitors have similar rates of adverse events and treatment response in ankylosing spondylitis regardless of whether the disease developed early or late in life, according to data published in Scientific Reports.
“It is rare for symptoms [of ankylosing spondylitis] to appear after the age of 45,” Sadettin Uslu, MD, of the division of rheumatology at the Celal Bayar University School of Medicine, in Turkey, and colleagues wrote. “While there are guidelines on the use of sulfasalazine and non-steroidal anti-inflammatory drugs in elderly or [late-onset ankylosing spondylitis] patients, there are not many studies in the literature on the usage of TNF inhibitors.”
To learn more about the efficacy, safety and adherence levels that can be expected with TNF inhibitors in late-onset AS, Uslu and colleagues conducted a study of data from the Turkish Biological Database, a nationwide registry. The analysis included 2,573 patients with young-onset AS — defined as those aged 45 years or younger at onset — and 281 with late-onset — those aged 45 years or older at onset — all of whom were biologic naïve and initiating their first TNF inhibitor.
Disease activity was measured using several metrics, including the Bath Ankylosing Spondylitis Disease Activity Index and the Ankylosing Spondylitis Disease Activity Score. Retention rates were determined using the number of days between each patient’s documented start of treatment the date they stopped.
According to the researchers, there were “no significant differences” between the two groups’ treatment response or adherence to treatment from 6 months to 24 months. The retention rate at 24 months was 72.9% for both groups, with the most common reasons being inefficacy, adverse events and remission. Rates of adverse events were similar between the groups, at 8.7% among the young-onset cohort and 11.7% for the late-onset patients. Among those with late-onset disease, discontinuation of TNF inhibitors was associated with a higher score on the visual analog scale for pain (HR = 1.04; 95% CI, 1.01-1.06).
“These findings suggest that the management of [late-onset AS] patients with [TNF inhibitor] therapy can be similar to that of [young-onset AS] patients,” Uslu and colleagues wrote. “Considering the potentially higher risk of [adverse events] related to NSAID use in [late-onset AS] patients, it is advisable to proceed with [TNF inhibitor] therapy when it is warranted, provided that it is accompanied by proper indications and diligent follow-up. To validate these results, further engagement of [late-onset AS] patients in clinical and epidemiological studies is essential.”
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