Session Information
Date: Tuesday, October 23, 2018
Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Treatment
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Lack of efficacy (LOE) to TNF inhibitor (TNFi) treatments is an important issue and can be seen in up to 40% of the patients with axial Spondyloarthritis (axSpA). In patients with LOE, further treatment responses have been reported to be lower: 6 month BASDAI 50% response rates of 37% for a 2nd TNFi and 30% for a 3rd TNFi. Secukinumab, an IL-17 inhibitor (IL-17i) is a relatively new treatment option for patients with active axSpA. However, there are currently limited data regarding the treatment responses in inadequate responders to ≥2 prior TNFi agents.
We aimed to compare the treatment outcomes of patients switching to TNFi or IL-17i following LOE to ≥2 TNFi.
Methods: Patients who fulfilled ASAS classification criteria for axSpA and who were on the 3rd or 4th biologic because of LOE to prior biologic treatments were identified. Patients who discontinued prior biologics because of intolerance or financial reasons were excluded. Patients were stratified into two groups based on the class of most recent biologic: TNFi or IL-17i. Demographic and clinical data including disease activity scores were collected from the database. Treatment responses at 6 months were compared between the groups. Good response was defined as ≥2 unit or ≥50% decrease in BASDAI. Other outcome measures assessed include clinically important improvement (CII; Δ≥1.1) and major improvement (ASDAS-MI; Δ≥2.0) in ASDAS-CRP.
Results: There were 106 patients (89 AS, 17 nr-axSpA) on a 3rd or 4th course of biologic medication following LOE to former biologic agents. Overall, 34 patients were on IL-17i and 72 on TNFi. Baseline demographics and clinical parameters are presented in Table 1. In the IL-17i group there were more patients with psoriasis and only one with IBD. There was no significant difference in other parameters between groups. The response rates were similar in IL-17i and TNFi treated patients (Table2). BASDAI ≥2 response rates were 15.2% for IL-17i and 14.8% for TNFi. ASDAS-CII was seen in 3.0% for IL-17i and 11.7% for TNFi. No patients achieved ASDAS-MI and there was no significant difference between sexes in the analysis.
Table:1 Baseline demographics and clinical parameters of 3rd and 4th biologic users
|
|
TNFi group (n:72) |
IL-17i group (n:34) |
p value |
|
Sex, male, n (%) |
48 (66.7%) |
21 (61.8%) |
0.67 |
|
Age (mean±SD) |
39.2±13.6 |
40.0±11.3 |
0.79 |
|
Dis. Duration (mean±SD) |
16.2±11.6 |
19.3±10.3 |
0.21 |
|
Baseline ESR (mean±SD) |
13.2±18.2 |
17.1±16.3 |
0.32 |
|
AS, n (%) |
60 (83.3) |
29 (85.3) |
0.52 |
|
Nr-axSpA, n (%) |
12 (16.7) |
5 (14.7) |
0.52 |
|
HLA B27 +, n (%) |
50 (69.4) |
25 (73.5) |
0.43 |
|
Baseline CRP (mean±SD) |
10.3±18.9 |
10.65±21.7 |
0.93 |
|
Baseline BASDAI (mean±SD) |
6.04±1.7 |
6.3±1.5 |
0.47 |
|
Baseline TBP (mean±SD) |
6.3±2.1 |
6.9±1.8 |
0.12 |
|
Baseline PGA (mean±SD) |
6.3±2.2 |
6.7±1.8 |
0.37 |
|
Baseline BASDAI |
6.0±1.7 |
6.3±1.5 |
0.47 |
|
Baseline ASDAS ESR |
3.0±0.9 |
3.3±0.8 |
0.07 |
|
Baseline ASDAS CRP |
3.3±0.9 |
3.5±0.8 |
0.30 |
|
Arthritis, n (%) |
63 (87.5) |
32 (94.1) |
0.24 |
|
IBD, n (%) |
14 (19.4) |
1 (2.9) |
0.017 |
|
Psoriasis, n (%) |
11 (15.3) |
11 (32.4) |
0.04 |
|
Enthesitis n (%) |
35 (48.6) |
20 (58.8) |
0.40 |
|
Uveitis, n (%) |
27 (37.5) |
13 (38.2) |
0.56 |
|
F. History of SpA, n (%) |
17 (23.6) |
6 (17.6) |
0.34 |
|
Smoking History, n (%) |
32 (44.4) |
13 (38.2) |
0.35 |
Table 2: Clinical response rates of 3rd and 4th biologic users
|
|
TNFi group (n:60) |
IL-17i group (n:33) |
p value |
|
BASDAI ≥2 unit, n (%) |
9 (14.8) |
5 (15.2) |
0.59 |
|
BASDAI 50 n (%) |
3 (4.9) |
2 (6.1) |
0.58 |
|
CII ASDAS CRP, n (%) |
7 (11.7) |
1 (3.0) |
0.25 |
CII: Clinically Important Improvement; Δ≥1.1 in ASDAS CRP.
There were no patients with major improvement.
Conclusion: Clinical response rates to a 3rd or 4th biologic, regardless of class, were low in AxSpA patients.
To cite this abstract in AMA style:
Tunc SE, Sari I, Inman RD, Haroon N. Multidrug Resistant AxSpA: No Advantage of Switching Class in Patients with Inadequate Response to Two Prior TNFi Agents [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/multidrug-resistant-axspa-no-advantage-of-switching-class-in-patients-with-inadequate-response-to-two-prior-tnfi-agents/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/multidrug-resistant-axspa-no-advantage-of-switching-class-in-patients-with-inadequate-response-to-two-prior-tnfi-agents/