Predictors of Treatment Response to Tumor Necrosis Factor-Alpha Blockers in Spondyloarthritis: Systematic Review and Meta-Analysis.

Background/Purpose:

TNF blockers have demonstrated substantial clinical efficacy in spondyloarthritis patients, and are usually indicated in patients showing active disease after failure to conventional treatment with NSAIDS or conventional DMARDs in peripheral presentations of the disease. However the relevant but inconstant and “only” symptomatic efficacy of the drugs in axial disease, together with the cost and possible side effects may argue to a better selection of suitable patients before starting TNF blockers. Our objective was to identify the baseline factors potentially predictive of a good response to TNF blockers in patients with spondyloarthritis.

Methods:

A systematic search of literature up to January 2014 was performed, in MEDLINE, EMBASE, the Cochrane library and abstracts from the ACR, EULAR and French national congresses from 2010 to 2013. Studies were included if they reported the response to TNF blockers based on the baseline parameters. After systematic collection of available data, a meta-analysis was conducted for every suitable outcome reported with potentially relevant baseline variables in at least 3 independent studies.

Results:

The literature search identified 2340 articles and 1 congress abstract. Finally, 33 articles and one abstract could be included according the predefined requirements. The meta-analysis of data of 4 studies showed a significantly increased treatment response BASDAI 50 in patients HLA B27 positive (OR 2.03 [95%CI 1.53-2.70]). Lower BASFI was predictor of response BASDAI 50 to treatment (OR 0.88 [95%CI 0.84-0.93] per BASFI unit/10), likewise younger age (OR 0.97 [95%CI 0.96-0.98] per additional age in years) in meta-analysis of data of 4 studies, and shorter disease duration (OR 0.95 [95%CI 0.90-1.00] per additional age in years). Elevated C-reactive protein concentration was predictor of achieving ASAS 40 response (OR 2.66 [95%CI 1.39-5.08]) in meta-analysis of data from 3 studies.

Conclusion:

This meta-analysis has identified increased acute phase reactants, younger age, shorter disease duration and HLA-B27 positivity as baseline predictors for achieving good clinical response to TNF-a blocking therapy. This may help clinicians in making treatment decisions in daily practice.