ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 699

In Contrast to Men, Women with Nonradiographic Axial Spondyloarthritis Have Lower Response Rates to TNF Inhibitors Than Women with Ankylosing Spondylitis

Adrian Ciurea1, Monika Hebeisen2, Ulrich Weber3,4, Giorgio Tamborrini5, Raphael Micheroli1, Lukas Wildi1, Pascal Zufferey6, Michael J. Nissen7, Peter M. Villiger8, Juerg Bernhard9, Désirée van der Heijde10, RBM Landewé11,12, Almut Scherer2 and Pascale Exer13, 1Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland, 2SCQM Foundation, Zurich, Switzerland, 3Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark, 4Department of Research, King Christian 10th Hospital for Rheumatic Diseases, Graasten, Denmark, 5Department of Rheumatology and Musculoskeletal Ultrasound, Bethesda Hospital Basel, Basel, Switzerland, 6Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, 7Rheumatology, Geneva University Hospital, Geneva, Switzerland, 8Rheumatology, Clinical immunology & Alllergology, University Hospital Bern, Bern, Switzerland, 9Rheumatology Center, Buergerspital, Solothurn, Switzerland, 10Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 11Division of Clinical Immunology and Rheumatology, Academic Medical Center / University of Amsterdam, Amsterdam, Netherlands, 12Zuyderland Medical Center, Heerlen, Netherlands, Heerlen, Netherlands, 13Private rheumatology practice, Basel, Switzerland

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , ,

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

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

Background/Purpose: Response to tumor necrosis factor inhibition (TNFi) has been shown to be similar in nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) in patients with objective signs of inflammation, such as an elevated C-reactive protein (CRP) and/or sacroiliitis on MRI. As men and women with axSpA differ with regard to the proportion of patients with elevated CRP and acute inflammation observed on MRI, we aimed at comparing response to TNFi in nr-axSpA versus AS after stratification by sex.

Methods: Patients within the Swiss Clinical Quality Management cohort fulfilling the Assessment of Spondyloarthritis international Society (ASAS) classification for axSpA were included in the current study if they a) had a baseline pelvic X-ray, b) started a first TNFi after inclusion in the cohort and c) had a follow-up visit at 1 year (± 6 months). We excluded patients with known fibromyalgia as a co-morbidity. The proportion of patients achieving the ASAS criteria for 40% improvement (ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement criteria and status scores were evaluated at 1 year. Patients having discontinued the TNFi were considered non-responders.

Results: Baseline characteristics of 152 women and 267 men included in the analyses are shown in Table 1, stratified by classification status. In contrast to men, the proportions of patients with elevated CRP levels, peripheral arthritis and enthesitis were similarly distributed in nr-axSpA versus AS in women starting a first TNFi. The proportion of patients with different numbers of classifying axSpA features was comparable in AS versus nr-axSpA in both genders. With regard to response to TNFi, similar proportions of men with nr-axSpA and AS achieved an ASAS40 response (38% versus 45%; odds ratio (OR) 0.75, 95% confidence interval (CI) 0.35-1.56, p=0.49), as well as all ASDAS response criteria (Table 2). By contrast, a significantly lower proportion of women with nr-axSpA compared to women with AS achieved a clinical response according to the different criteria assessed (ASAS40 response of 17% versus 42%, OR 0.28, 95% CI 0.10-0.70, p=0.004 in women with nr-axSpA versus AS, respectively).

Conclusion: While men with nr-axSpA have similar response rates as men with AS, significantly lower response rates are found in women with nr-axSpA in comparison to women with AS. The results are in line with randomized controlled trials of adalimumab and golimumab in nr-axSpA, showing lower response rates in women compared to men. Table 1. Baseline characteristics in women and men with nr-axSpA versus AS at start of first TNF inhibitor

Women

Men

Parameter

Nr-axSpA

N = 57

AS

N = 95

P

Nr-axSpA

N = 51

AS

N = 216

P

Age, years

37.6 ± 11.3

40.0  ± 11.3

0.28

35.7 ± 10.9

40.5 ± 11.5

0.01

Symptom duration, years

9.8 ± 10.6

13.2 ±  9.7

0.003

8.0 ± 8.3

15.5 ± 10.9

<0.001

HLA-B27 positive, %

73.5

74.1

1.00

75.0

87.1

0.04

BASDAI

6.0 ± 1.7

5.8 ± 2.0

0.72

5.4 ± 2.0

5.5 ± 2.0

0.79

ASDAS-CRP

3.4 ± 0.7

3.5 ± 1.1

0.78

3.4 ± 0.9)

3.6 ± 0.9

0.09

CRP (mg/l)

8.9 ± 8.2

17.4 ± 25.4

0.14

14.9 ± 23.6

18.5 ± 20.8

0.02

Elevated CRP, %

48.1

60.0

0.22

44.4

66.3

0.01

BASFI

3.2 ± 2.3

4.4 ± 2.6

0.009

3.8 ± 2.4

4.4 ± 2.4

0.12

BASMI

1.4 ± 1.3

2.0 ± 1.7

0.07

1.3 ± 1.5

3.1 ± 2.3

<0.001

EQ-5D

56.5 ±  17.9

54.9 ± 21.4

0.68

52.6 ± 22.7

53.8 ± 21.4

0.87

Peripheral arthritis, %

52.8

45.0

0.39

45.1

29.5

0.04

Number of swollen joints

1.6 ± 3.1

1.5 ± 4.1

0.33

0.8 ± 1.5

0.7 ± 1.9

0.10

Enthesitis, %

83.0

77.7

0.53

80.4

65.5

0.04

Modified MASES

3.6 ± 3.5

3.1 ± 3.5

0.28

2.5 ± 3.0

2.2 ± 2.8

0.47

Table 2. Response rates after 1 year of treatment with a first TNF inhibitor

nr-axSpA

N (%)

AS

N (%)

OR

95% CI

P

Women

ASAS40

8 (16.7)

35 (42.2)

0.28

0.10-0.70

0.004

ASDAS clinically  important improvement

8 (19.0)

35 (51.5)

0.22

0.08-0.59

0.001

ASDAS <2.1

10 (22.7)

37 (49.3)

0.31

0.12-0.74

0.006

ASDAS major improvement

2 (4.8)

17 (25.0)

0.15

0.02-0.70

0.008

ASDAS <1.3

3 (6.8)

14 (18.7)

0.32

0.06-1.25

0.10

Men

ASAS40

16 (38.1)

84 (45.2)

0.75

0.35-1.56

0.49

ASDAS clinically important improvement

18 (52.9)

100 (59.2)

0.78

0.35-1.75

0.57

ASDAS <2.1

18 (42.9)

91 (50.3)

0.74

0.35-1.54

0.40

ASDAS major improvement

6 (17.6)

52 (30.8)

0.48

0.15-1.29

0.15

ASDAS <1.3

8 (19.0)

44 (24.3)

0.73

0.27-1.77

0.55

Disclosure: A. Ciurea, Abbvie, 2; M. Hebeisen, None; U. Weber, None; G. Tamborrini, None; R. Micheroli, None; L. Wildi, None; P. Zufferey, None; M. J. Nissen, None; P. M. Villiger, None; J. Bernhard, None; D. van der Heijde, None; R. Landewé, None; A. Scherer, None; P. Exer, None.

To cite this abstract in AMA style:

Ciurea A, Hebeisen M, Weber U, Tamborrini G, Micheroli R, Wildi L, Zufferey P, Nissen MJ, Villiger PM, Bernhard J, van der Heijde D, Landewé R, Scherer A, Exer P. In Contrast to Men, Women with Nonradiographic Axial Spondyloarthritis Have Lower Response Rates to TNF Inhibitors Than Women with Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/in-contrast-to-men-women-with-nonradiographic-axial-spondyloarthritis-have-lower-response-rates-to-tnf-inhibitors-than-women-with-ankylosing-spondylitis/. Accessed .

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