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Abstract Number: 1538

Comparative Effectiveness of Early Versus Delayed Anti-TNF-α Treatment in Axial Spondyloarthritis

Herman F Mann1, Jakub Zavada2, Šárka Forejtová3, Lenka Szczukova4, Zlatuše Křístková4 and Karel Pavelka1, 1ATTRA, Prague, Czech Republic, Prague, Czech Republic, 2Institute of Rheumatology, Prague, Czech Republic, 3Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Czech Republic, Prague, Czech Republic, 4Institute of Biostatistics and Analyses. Faculty of Medicine, Masaryk University, Brno, Czech Republic

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: anti-TNF therapy and axial spondyloarthritis, Disease Activity

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Session Information

Date: Monday, November 6, 2017

Session Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Anti-TNF-α agents are the mainstay of pharmacotherapy for patients with axial spondyloarthritis (AxSpA) who failed treatment with NSAIDs. A little is known about the influence of early versus delayed treatment initiation on their clinical efficacy.

Methods: Baseline demographic data and efficacy parameters of patients starting their first anti-TNF-α treatment ≤ 3 years (EARLY) or > 3 years (DEALYED) after diagnosis of AxSpA from the Czech national registry ATTRA were compared. ATTRA is a centralized prospective computerized registry of patients receiving bDMARD therapy for rheumatic diseases collecting data on efficacy, safety and quality of life of all patients treated in the Czech Republic. Anti-TNF-α therapy was indicated for patients with AxSpA who have failed treatment with NSAIDs with CRP ≥ 1mg/dl and BASDAI score ≥ 4.

Results: Data from 1899 axSpA patients were available for analysis. 689 patients started treatment ≤ 3 years and 1210 > 3 years after the diagnosis of AxSpA. There was no difference in gender distribution (72% males) or mean CRP level (2.5 mg/dl) at the time of treatment initiation between EARLY and DELAYED groups. Patients in the EARLY group were significantly younger (mean age 36.4 ± 10.4 vs 42.2 ± 10.9 years; P < 0.001) with shorter symptom duration (8.1 ± 7,4 vs 15.1 ± 9.0 years; P < 0.001). EARLY patients were less likely to be HLA B27 positive (87.9% vs 93.2%; P < 0.001). Disease activity was assessed using BASDAI at months 0, 3, 6, 12, 18 and 24. Activity was higher in the DELAYED group at all timepoints with statistically significant differences at baseline (6.4 ± 1.7 vs 6.2 ± 1.7; P = 0.003), 6 (2.5 ± 1.9 vs 2.3 ± 1.8; P = 0.038), 18 (2.3 ± 1.8 vs 1.9 ± 1.7; P = 0.001) and 24 months (2.3 ± 1.8 vs 2.0 ± 1.8; P = 0.049). There was no difference in survival on therapy between the groups with 85% patients remaining on the initial treatment at 1 year and 77% at 2 years. Radiographic progression was not assessed.

Conclusion: AxSpA patients starting anti-TNF-α therapy later than 3 years after diagnosis had slightly higher activity before and during treatment, however the differences were small and survival on therapy was not different compared to patients with earlier treatment initiation.

Acknowledgement: This study was supported by the project of MHCR for conceptual development of research organization 00023728


Disclosure: H. F. Mann, None; J. Zavada, None; Š. Forejtová, None; L. Szczukova, None; Z. Křístková, None; K. Pavelka, None.

To cite this abstract in AMA style:

Mann HF, Zavada J, Forejtová Š, Szczukova L, Křístková Z, Pavelka K. Comparative Effectiveness of Early Versus Delayed Anti-TNF-α Treatment in Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/comparative-effectiveness-of-early-versus-delayed-anti-tnf-%ce%b1-treatment-in-axial-spondyloarthritis/. Accessed May 16, 2022.
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