Abstract | OBJECTIVE: METHODS: Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis ( nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. RESULTS: The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder-adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates ( nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). CONCLUSION: In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.
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Authors | Bente Glintborg, Inge J Sørensen, Mikkel Østergaard, Lene Dreyer, Abdiweli A Mohamoud, Niels S Krogh, Oliver Hendricks, Lis S Andersen, Johnny L Raun, Marcin R Kowalski, Laura Danielsen, Randi Pelck, Henrik Nordin, Jens K Pedersen, Dorte G A Kraus, Susan R Christensen, Inger M J Hansen, Jakob Esbesen, Annette Schlemmer, Anne G Loft, Nabil Al Chaer, Lone Salomonsen, Merete L Hetland |
Journal | The Journal of rheumatology
(J Rheumatol)
Vol. 44
Issue 1
Pg. 59-69
(01 2017)
ISSN: 0315-162X [Print] Canada |
PMID | 27909080
(Publication Type: Journal Article, Observational Study)
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Chemical References |
- Antirheumatic Agents
- Biological Products
- HLA-B27 Antigen
- Tumor Necrosis Factor-alpha
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Topics |
- Adult
- Antirheumatic Agents
(therapeutic use)
- Biological Products
(therapeutic use)
- Cohort Studies
- Female
- HLA-B27 Antigen
(blood)
- Humans
- Male
- Medication Adherence
- Middle Aged
- Registries
- Sacroiliac Joint
(diagnostic imaging)
- Severity of Illness Index
- Spondylarthritis
(diagnostic imaging, drug therapy, genetics)
- Spondylitis, Ankylosing
(blood, diagnostic imaging, drug therapy)
- Treatment Outcome
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
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