Is a Primary Good Response to Nsaids Predictive of the Subsequent Response to the First TNF Inhibitor in Patients with Early Axial Spondyloarthritis ?

Loukianos Couvaras¹, Daniel Wendling², Vanessa Pauly³, Vincent Pradel⁴, Anna Molto⁵, Pierre Lafforgue¹ and Thao Pham⁶, ¹Rheumatology, Aix-Marseille University, APHM, Marseille, France, ²service de rhumatologie, CHU J Minjoz, Besancon, France, ³Public Health, Aix-Marseille university, AP-HM, Marseille, France, ⁴Public Health, APHM, Marseille, France, ⁵Hôpital Cochin, Department of Rheumatology, Paris Descartes University, Paris, France, ⁶Rheumatology Department, Aix-Marseille University, APHM, Marseille, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: anti-TNF therapy, nonsteroidal antiinflammatory drugs (NSAIDs) and spondylarthritis

Session Information

Date: Sunday, October 21, 2018

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Imaging, Clinical Studies, and Treatment

Session Type: ACR Poster Session A

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

Background/Purpose:

Good response to NSAIDs is a SpA feature included in classification criteria for axial spondyloarthritis (axSpA). Among patients eligible for a TNF inhibitor (TNFi), some patients may have never responded to NSAIDs (NSAIDs non-responders) while others primary responded before secondary failure (NSAIDs responders). Our aim was to determine if the primary NSAIDs response is an independent predictive factor of a subsequent good response to the first TNFi in patients with early axSpA.

Methods:

Patients: Subjects from the prospective observational DESIR cohort of early axSpA cohort who started a TNFi over the 5 years of follow-up.

NSAIDs response and TNFi response definitions: NSAIDs response was defined by the item “good response to NSAIDs according to Amor’s criteria” at the inclusion visit. TNFi response was defined by the BASDAI50 response between the “baseline” visit (last cohort visit before TNFi initiation) and the “follow-up” visit (visit taking place after at least 8 weeks of TNFi treatment).

Analysis
We compared the characteristics of the NSAIDs responder to the non-responders and their response to the first TNFi. We performed a multivariate logistic regression modeling the impact of an NSAID response to the TNFi response. We included known predictive factors of TNFi response in this model (age, gender, HLAB-B27, activity of the disease [ASDAS-CRP], CRP, X- ray and MRI sacroiliitis). To account for selection bias and for confirmation purpose, we applied a propensity score with Inverse Probability Weighting (IPW) method to predict TNFi response (SAS, version 9.2).

Results:

Among the 708 patients of the cohort, 236 were included in the analysis. At baseline, the main characteristics were the following: 106 (44.9%) males, mean age 33.9 ± 8.9 years, mean BASDAI 54.4 ± 17.3 and 202 (85.6%) were NSAIDs responders. The NSAIDs responder and non-responder groups were comparable at M0 except for HLA-B27 positive status: 59.9% vs 41.2%, p = 0,041, history of psoriasis: 17.8% vs 35.3%, p = 0.019 and BASDAI: 53.0 ± 18.1 vs 61.8 ± 13.2, p = 0,001, in responder and non-responder patients, respectively.
The percentage of TNFi responders was 32.2% (65/202) and 23.5% (8/34) in the NSAIDs responder and non-responder groups, respectively (univariate analysis (OR 1.5 [IC95%: 0.7-3.6], p = 0.313).
The multivariate logistic regression found the following independent factors of the TNFi response: gender [adjusted OR (aOR) = 2.9 [CI95%: 1.4–6.0], p=0.004], age [aOR = 0.9 [CI95%: 0.91-0.99], p=0.026], HLA-B27 status [aOR = 2.5 [CI95 %: 1.2–5.3], p = 0.02], ASDAS-CRP score [aOR=1.6 [CI95 %: 1.1–2.4], p = 0.016], and MRI sacroiliitis [aOR = 2.0 [CI95 %: 1.0–4.2], p = 0.054]. Response to NSAIDs was not significantly associated to the response to the TNFi [aOR = 1.93 [CI95 %: 0.6-6.3], p = 0.275]. The IPW aOR confirmed the non-association between NSAIDs good response and TNFi good response: 1.60 [CI95%: 0.7–3.3], p = 0.20.

Conclusion:

NSAIDs good response, according to the Amor’s criteria, does not seem to be an independent predictive factor of the subsequent TNFi response in early axSpA patients.

Disclosure: L. Couvaras, None; D. Wendling, None; V. Pauly, None; V. Pradel, None; A. Molto, None; P. Lafforgue, None; T. Pham, None.

To cite this abstract in AMA style:

Couvaras L, Wendling D, Pauly V, Pradel V, Molto A, Lafforgue P, Pham T. Is a Primary Good Response to Nsaids Predictive of the Subsequent Response to the First TNF Inhibitor in Patients with Early Axial Spondyloarthritis ? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/is-a-primary-good-response-to-nsaids-predictive-of-the-subsequent-response-to-the-first-tnf-inhibitor-in-patients-with-early-axial-spondyloarthritis/. Accessed February 2, 2023.

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