Background/Purpose:  to analyze the frequency of patients with axSpA achieving maintained remission (R) or low disease activity (LDA) after receiving biological therapy. Secondary objectives included: i) to assess if the activity index used influences the frequency of maintained R/LDA, ii) analyze the prognostic factors for achieving maintained R/LDA.

Methods: an observational, longitudinal study of a prospective cohort (SpA-Paz) including all patients with axSpA who initiated biological treatment between the years 2003-2017. Demographic, clinical and analytical data were collected at the beginning of treatment and clinical disease activity measured by BASDAI&CRP and ASDAS every 6 months for at least 2 years. Maintained R was defined as (BASDAI < 2 & normal CRP and / or ASDAS < 1.3) and maintained LDA (BASDAI < 4 & normal CRP and / or ASDAS < 2.1) on at least 3 consecutive visits. Statistical analysis: i) measures of central tendency and dispersion for quantitative variables and frequencies for qualitative variables; ii) univariate and multivariate analysis of binomial logistic regression model and calculation of OR and 95% CI.

Results: Out of 186 patients with axSpA who initiated their first biological therapy during the study period, 63% were men with a mean age of 54 ± 14.1 years. 75.3% of the patients had radiographic axSpA and 74.7% were HLA-B27 positive. Other baseline characteristics are shown in Table 1. Overall, 80% of the patients achieved ASDAS R/LDA (R36%/LDA44%) in at least one of the visits after 2 years of follow-up, but only 40% (R27%/LDA13%) of the patients fulfilled the maintained ASDAS R/LDA state. On the other hand, 73% of patients were classified as BASDAI&CRP R/LDA (R31%/LDA42%) in at least one of the visits, but only 31% (R21%/LDA10%) of the patients obtained the maintained BASDAI&CRP R/LDA state. In the multivariate analysis, we observed an independent statistically significant association with male sex (OR=3.19; 95% CI=1.46-6.99), being younger at the beginning of the biological treatment (OR= 0.97; 95% CI=0.95-0.99) and the use of methotrexate (OR=3.07; 95% CI =1.39-6.78) in patients who achieved maintained BASDAI&CRP R/LDA and with male sex (OR=4.01; 95% CI=1.83-8.77), younger age at the beginning of the biological therapy (OR=0.96; 95% CI=0.94-0.99) and B27 positive (OR=4.30; 95% CI=1.68-11.01) in patients who achieved maintained ASDAS R/LDA.

Conclusion: Although most patients with axSpA who initiate biological therapy achieve the recommended therapeutic goal in the first two years of biological treatment, the percentage of patients who manage to maintain the R/LDA status is limited. In our study, maintained R was more frequent than maintained LDA, being somewhat higher when measured by ASDAS. This fact may suggest that patients who achieve maintained R have a greater inhibition of their inflammatory activity and, therefore, it remains in time. Male sex and younger age at the beginning of the biological therapy were the main baseline predictors for achieving maintained R /LDA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-it-feasible-to-achieve-recommended-therapeutic-target-objective-in-patients-with-axial-spondyloarthritis-in-clinical-practice-data-from-the-spa-paz-cohort/