Background/Purpose:     < style="text-align: justify;">In patients with early axial spondyloarthritis (SpA) with a disease duration of < 5 years and evidence of active inflammation on whole-body magnetic resonance imaging (wb-MRI) in the spine and/or sacroiliac joints (SIJ) at baseline [1] the long-term efficacy of etanercept (ETN) was assessed over three years.

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Methods:

In the previously reported ESTHER trial axial SpA patients were treated with ETN (n= 40) versus sulfasalazine (SSZ) (n= 36) in the first year [1]. All patients who were not in remission at week 48 (n=48) were either continuously treated with ETN, or sulfasalazine treatment was switched to ETN treatment. We analysed the clinical and MRI response in he pooled data set of patients who were continously treated with ETN for 3 consecutive years. Data were analysed as observed.

Results:

In the pooled group of patients treated continously over 3 years with ETN (n= 60) the BASDAI decreased from 5.7 (standard deviation 1.3) to 2.0 (1.5), the ASDAS from 3.4 (0.8) to 1.2 (0.7). Also mean values for MRI spine and sacroiliac joint scores showed a significant decrease (table 1). ASAS partial remission after three years of ETA was reached by 43%, ASDAS inactive disease by 60% (table 1).

Conclusion:

There was a constant and sustained clinical response in patients with early axial SpA patients treated with ETN over 3 years. The response in this early axial SpA cohort seems to be better compared to established AS cohorts with a longer disease duration (> 10 years) where BASDAI50 response rates of 47% after 3 years of infliximab treatment [3] and ASAS40 and ASAS partial remission rates of 49% and 27%, respectively after 4 years of etanercept treatment [4] were reported.

Table 1: Long-term efficacy over 3 years in patients with early axial spondyloarthritis treated with etanercept. Data at baseline (BL), after one year of treatment with etanercept, after two years and after three years of treatment with etanercept.

	ETN, Baseline	Data after one year of treatment with ETN	Data after two years of treatment with ETN	Data after three years of treatment with ETN
BASDAI (0-10)	5.7 (1.3)	2.5 (2.0)	2.1 (1.8)	2.0 (1.5)
BASFI (0-10)	4.4 (2.1)	2.0 (2.0)	1.6 (1.7)	1.4 (1.3)
ASDAS (0- …)	3.4 (0.8)	1.6 (0.8)	1.4 (0.9)	1.2 (0.7)
CRP (mg/l)	10.5 (13.6)	3.5 (4.6)	3.6 (5.5)	2.9 (5.5)
MRI Spine Score (-69)	1.6 (3.4)	NA	0.7 (1.4)	0.9 (1.8)
MRI SI-joint Score (-24)	4.6 (6.3)	NA	3.5 (6.1)	3.3 (6.0)
ASAS40, %	NA	68.4%	67.4%	75.0%
ASAS PR, %	NA	35.1%	53.5%	42.5%
ASDAS inactive disease, %	NA	38.9%	53.7%	60.0%
BASDAI50, %	NA	64.9%	65.1%	72.5%

Data shown as mean values (standard deviation) unless otherwise stated. Abbreviations: ETN: etanercept; ASAS PR: ASAS partial remission; NA: not applicable; BASDAI : Bath Ankylosing Spondylitis Disease Activity Index ; ASDAS : Ankylosing Spondylitis Disease Activity Score ; ASAS : Assessment of SpondyloArthritis international Society; MRI: magnetic resonance imaging; SI-joint: sacroiliac joint;

 

1. Song I.-H. et al. Ann Rheum Dis. 2011;70(4):590-596.
2. Song I.-H. et al. Ann Rheum Dis. 2012;71(7):1212-1215.
3. Braun J. et al. Rheumatology 2005;44:670–676
4. Davis JC et al. Ann Rheum Dis. 2008;67(3):346-353

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/stable-clinical-and-mri-response-in-patients-with-early-axial-spondyloarthritis-after-3-years-of-continuous-treatment-with-etanercept-data-of-the-esther-trial/