ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2725

Elevated Disease Activity in Disease-Related Spondyloarthritis Despite Use of Tumor Necrosis Factor Inhibitor Therapies

Delamo Bekele1, Ryan Duong2, Patrick R. Wood3, Mena Hashim4, Jason Hou5, Jessica Walsh6, Maureen Dubreuil7,8, Daniel Clegg9, Prashant Kaushik10, Bernard Ng11,12, Elizabeth Chang13, Andreas M. Reimold14, Liron Caplan15 and Gail S. Kerr16, 1Medicine, Howard University Hospital, Washington, DC, 2Rheumatology, Denver Veterans Affairs Medical Center and UC Denver SOM, Denver, CO, 3Internal Medicine, University of Colorado School of Medicine, Aurora, CO, 4Denver VAMC, Denver, CO, 5Gastroenterology, Houston VAMC and Baylor College of Medicine, Houston, TX, 6Division of Rheumatology, Salt Lake City Veteran Affairs and University of Utah Medical Centers, Salt Lake City, UT, 7Rheumatology, Boston VA HealthCare System, Boston, MA, 8Rheumatology, Boston University Medical Center, Boston, MA, 9Rheumatology, Salt Lake City Veteran Affairs and University of Utah Medical Centers, Salt Lake City, UT, 10Rheumatology/Medicine, Stratton VAMC, Albany, NY, 11Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, 12Rheumatology, VA Puget Sound Healthcare System, Seattle, WA, 13Rheumatology, Veterans Affairs, Phoenix, AZ, 14Rheumatology, VAMC and University of Texas Southwestern, Dallas, TX, 15Div of Rheumatology, Denver VA and University of Colorado School of Medicine, Aurora, CO, 16Washington DC VAMC, Georgetown University Hospital, Howard University Hospital, Washington, DC

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

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:   Spondyloarthritis (SpA) includes a wide range of overlapping diseases for which there are a limited number of approved pharmacologic agents that have been shown to modify disease course. To date, tumor necrosis factor inhibitors (TNFi) are the most effective treatments available that improve function and alleviate symptoms.  However, the extent to which TNFi ameliorates SpA disease activity in routine care remains unclear.  We examined the frequencies of elevated Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores in SpA patients receiving TNFi. 

Methods: Patients with SpA-related diseases who were receiving a TNFi and enrolled in the Veterans Affairs’ Program to Understand the Long-term Outcomes in Spondyloarthritis (PULSAR) registry were eligible for study. Standardized electronic medical record templates obtained at routine clinic visits from Sept. 2007 – June 2016 provided the clinical study data. A modified, validated version of the BASDAI (replacing the term “Ankylosing Spondylitis” with “inflammatory arthritis”),  was administered to subjects, and mean BASDAI scores were computed.  We determined the prevalence of BASDAI≥4 among subjects with axial SpA, determined by SpA phenotype and use of TNFi.  

Results:  There were 596 PULSAR patients; 91% were male, 70% were Caucasian and 11% African American. The mean age at SpA diagnosis was 55 years.  The majority either had ankylosing spondylitis or psoriatic arthritis.  Forty-four percent were HLA-B27 positive, and the mean ESR and CRP value at enrollment was 18 mm/hr and 8.94 mg/L, respectively. Baseline BASDAI of SpA patients (regardless of phenotype) was 5.28.  There were 385 on TNFi during the study period (Table). A BASDAI of ≥4 was recorded in approximately 60% of those treated with TNFi, including at their most recent encounter.

Conclusion:   In a SpA cohort of US veterans, active disease persisted in a majority of TNFi- treated patients, potentially indicative of the need for more intensive or alternate therapies.   Table: Active BASDAI ≥4 scores in SpA patients receiving TNFi  

  AS PsA EAA ReA
Total (n=596) 260 246 36 54
SpA on TNFi n =385, (% cohort) 172 (66.2%) 167 (67.9) 17 (47.2) 29 (53.7)
BASDAI≥4 ever 145 (84.3%) 136 (81.4%) 11 (64.7%) 22 (75.9%)
BASDAI≥4 (mean, all observations) 132 (76.7%) 118 (70.7%) 10 (58.8%) 22 (75.9%)
BASDAI≥4 (when receiving TNFi) 129 (75%) 115 (68.9%) 9 (52.9%) 21 (72.4%)
BASDAI≥4 (most recent visit) 104 (60.5%) 100 (59.9%) 8 (47.1%) 18 (62.1%)
AS = ankylosing spondylitis, PsA = psoriatic arthritis, EAA = enteric-associated arthritis, ReA = reactive arthritis, TNFi = Tumor necrosis factor inhibitor  
Disclosure: D. Bekele, None; R. Duong, None; P. R. Wood, None; M. Hashim, None; J. Hou, UCB, 5,Abbvie, 8; J. Walsh, Novartis Pharmaceutical Corporation, 5,Abbvie, 5; M. Dubreuil, None; D. Clegg, Janssen Pharmaceutica Product, L.P., 5; P. Kaushik, None; B. Ng, None; E. Chang, None; A. M. Reimold, Abbvie, 2,Novartis Pharmaceutical Corporation, 2; L. Caplan, None; G. S. Kerr, UCB, Janssen, 9.

To cite this abstract in AMA style:

Bekele D, Duong R, Wood PR, Hashim M, Hou J, Walsh J, Dubreuil M, Clegg D, Kaushik P, Ng B, Chang E, Reimold AM, Caplan L, Kerr GS. Elevated Disease Activity in Disease-Related Spondyloarthritis Despite Use of Tumor Necrosis Factor Inhibitor Therapies [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/elevated-disease-activity-in-disease-related-spondyloarthritis-despite-use-of-tumor-necrosis-factor-inhibitor-therapies/. Accessed .

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