AxSpA real-life remission rates higher on biologics

Randomised controlled trials have shown that remission occurs infrequently in axial spondyloarthritis (axSpA) patients treated without biologics [1,2]. Yet, data on remission rates in daily clinical practice are scarce. Thus, Dr Charlotte Baert (Saint Luc University Hospital, Belgium) and colleagues aimed to assess the remission rate in axSpA patients in real life, and to compare the remission rate in axSpA patients on non-steroidal anti-inflammatory drugs (NSAIDs) to the remission rate of those on biologic agents (i.e. tumour necrosis factor [TNF]α blockers or interleukin [IL]-17A blockers) [3].

This was a cross-sectional study that reviewed clinical data from a single centre (UCLouvain, Belgium) between January 2013 and March 2019, and the last visit available for clinical assessment was evaluated. The analysis included data from 551 axSpA patients of whom 64.3% were male. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP). Remission was defined as BASDAI <4 and ASDAS <1.3.

In the entire cohort, 478 BASDAI and 317 ASDAS were recorded. The remission rate was 46.7% (n=223) according to BASDAI and 17.3% for ASDAS (n=55). To identify the treatment-related remission rate, patients were stratified by their treatment: NSAIDs (n=285; 62.5% male) or biologics (n=266; 66% male). A total of 245 BASDAI were available for NSAIDs and 233 for biologics. Analysis showed 110 participants on NSAIDs (44.9%) and 113 patients on biologics (48.5%) who were in remission according to BASDAI. ASDAS data was available from 172 patients who were treated with NSAIDs and 144 treated with biologics. Of these, 27 (15.7%) and 28 (19.4%) were in remission for NSAIDs and biologics, respectively (P=0.853) (see Table).

Table: Distribution of ASDAS values in both treatment groups [3]

ASDAS, Ankylosing Spondylitis Disease Activity Score; NSAID, non-steroidal anti-inflammatory drugs.

The authors concluded that the real-life remission rate in axSpA patients seems to be higher in patients who are treated with biologics. However, compared with NSAIDs the difference is not significant, and many patients treated with NSAIDs achieve remission.

1. Deodhar A. et al. Arthritis Rheumatol 2019;71(7):1101-1111.
2. Sieper J. et al. Rheumatology 2016;55(11): 1946-1953.
3. Baert C, et al. FRI0268. EULAR E-Congress, 3-6 June 2020.

Posted on 14 August, 20205 August, 2021