Session Information
Date: Tuesday, November 15, 2016
Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Anti-TNFi agents are effective in the treatment of active AS. Based on the available data, nearly 20% of the AS patients needed to switch their anti-TNF medications to another TNFi agent because of the lack of efficacy (LOE). The reasons underlying the LOE is still remain largely unexplained. Herein we have investigated the characteristics of AS patients who have primary and secondary LOE to TNFi.
Methods: Adult AS patients registered in the axial SpA database who received TNFi treatments were identified. Based on the response to TNFi treatments, these patients were then classified into three groups: primary LOE, secondary LOE and responders. Patients were defined as primary LOE if the first TNFi was stopped within 6 months after start and secondary LOE if the first TNFi was discontinued after a 6-month period. On the other hand, patients who responded to their first TNFi for > 12 mos and currently on same TNFi at the time of last visit were defined as responders. Clinical, demographic and laboratory data were collected and analyzed.
Results: There were a total of 221 patients stratified as follows: primary LOE=51, secondary LOE=83 and responders=87. The mean age and disease duration of the study group patients were 37.4±12.4 and 14.8±10.4 years respectively. 72.4% of the total group was male and B27 positivity was 77.8%. The mean follow-up duration of the responders was 53.4±35.4 months. Comparison of three groups showed that age and disease duration were significantly lower in the primary LOE group compared to secondary LOE (p<0.05; 41.9±12.1 vs. 34.7±12.1 and 17±12.3 vs. 12.8±8.9 respectively). Among the clinical variables, the arthritis frequency was significantly lower in the responders group compared to both primary and secondary LOE patients (p<0.05; 42.5% vs. 60.8 and 72.3 respectively). The other variables including sex, B27 status, baseline BASDAI, BASFI and CRP, frequency of hip involvement, iritis, enthesitis, dactylitis, psoriasis, IBD and family history of SpA did not differ between the groups. Table 1 represents the characteristics of the three groups. Regression analysis showed that the predictors for primary LOE were increased age and presence of arthritis (p<0.05; OR=1.1 and 2.3 respectively). On the other hand negative B27 and arthritis were the predictors for the secondary LOE (p<0.05; OR=2.4 and 4 respectively). When we considered TNFi failures collectively the predictors for the non-response found to be the negative B27 and presence of arthritis (p<0.05; OR=2.1 and 3.3 respectively).
Conclusion: The results of our study from a longitudinal observational cohort of axial SpA patients indicates that only 39.4% (87/221) of the AS patients were considered sustained responders to TNFi. Our analysis suggests that the most important predictors for lack of response in AS patients were a negative B27 and presence of arthritis. Table 1:Clinical and demographical characteristics of the study group
| Primary LOE (n=51) | Secondary LOE (n=83) | Responders (n=87) | p value | |
| Age, yr | 41.9±12.1 | 34.7±12.1 | 37.6±12.1 | 0.04 |
| Males, % | 74.5 | 69.9 | 73.6 | 0.8 |
| Disease duration, yr | 17±12.3 | 12.8±8.9 | 15.4±10.2 | 0.04 |
| HLA-B27 positivity, % | 72.5 | 74.7 | 83.9 | 0.21 |
| Iritis, % | 31.4 | 34.9 | 28.7 | 0.68 |
| Arthritis, % | 60.8 | 72.3 | 42.5 | <0.0001 |
| Psoriasis, % | 23.5 | 9.6 | 13.8 | 0.08 |
| IBD, % | 13.7 | 21.7 | 9.2 | 0.07 |
| Dactylitis, % | 0 | 4.8 | 1.1 | 0.13 |
| Enthesitis, % | 52.9 | 49.4 | 42.5 | 0.45 |
| Increased acute phase reactants, % | 40 | 51.9 | 50.6 | 0.38 |
| Family history for SpA, % | 19.6 | 18.1 | 24.1 | 0.6 |
| Hip involvement, % | 15.7 | 13.3 | 5.7 | 0.13 |
| Baseline BASDAI | 6.3±1.4 | 6.4±2 | 5.9±2 | 0.36 |
| Baseline BASFI | 6.2±2.1 | 5.5±2.7 | 4.9±2.5 | 0.09 |
| Smoking ever, % | 7.8 | 16.9 | 18.4 | 0.53 |
To cite this abstract in AMA style:
Alazmi M, Sari I, Ayearst R, Haroon N, Inman RD. Characteristics of Ankylosing Spondylitis Patients with Primary and Secondary Lack of Efficacy to TNF-Inhibitor Treatments [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/characteristics-of-ankylosing-spondylitis-patients-with-primary-and-secondary-lack-of-efficacy-to-tnf-inhibitor-treatments/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/characteristics-of-ankylosing-spondylitis-patients-with-primary-and-secondary-lack-of-efficacy-to-tnf-inhibitor-treatments/