AI Article Synopsis
- A study aimed to assess the frequency of sustained remission (R) and low disease activity (LDA) in axial spondyloarthritis (axSpA) patients undergoing long-term biological therapy in a Spanish hospital.
- Among the 186 patients studied, 76.8% achieved some form of disease improvement at least once, but only about 40% maintained sustained R/LDA over time, particularly when using specific measures.
- Factors such as being male, younger age at therapy initiation, and testing positive for HLA*B27 were identified as predictors for achieving sustained improvement in disease activity.
Article Abstract
Objectives: To determine the frequency of sustained remission (R) or low diseas activity (LDA) in patients with axial spondyloarthritis (axSpA) undergoing long-term biological therapy and to analyse predictive factors for achieving these outcomes.
Design: Prospective, observational cohort study.
Setting: Spanish hospital.
Participants: Patients with axSpA who initiated biological treatment between 2003 and 2017.
Intervention: Assessment of demographic and clinical characteristics at the beginning of treatment and disease activity every 6 months up to a maximum of 2 years.
Main Outcome Measures: Disease activity was measured by Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index and C reactive protein (BASDAI&CRP). Sustained R was defined as ASDAS<1.3 and/or BASDAI <2 and normal CRP while sustained LDA was defined as ASDAS <2.1 and/or BASDAI <4 and normal CRP on at least three consecutive visits.
Results: In total 186 patients (66.1% men and 75.3% with radiographic sacroiliitis) were included. Overall, 76.8% of patients achieved ASDAS R/LDA (R53.2%/LDA23.6%) in at least one visit. Forty per cent (R17.6%/LDA22.4%) of the patients fulfilled the sustained ASDAS R/LDA state, whereas only 30.8% maintained this status (R14.8%/LDA15.9%) according to BASDAI&CRP. In the multivariate analysis, male sex (OR=4.01), younger age at the beginning of biological therapy (OR=0.96) and an HLA*B27 positive status (OR=4.30) were associated with achieving sustained ASDAS R/LDA.
Conclusions: In clinical practice, around one-third of patients on biological disease-modifying antirheumatic drugs achieve a sustained R/LDA status, but these rates drop to less than one in five when targeting remission, preventing the use of the latter as a feasible target. Male sex, HLA*B27 positivity and younger age at the beginning of biological therapy are the main predictors for achieving sustained R/LDA.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058765 | PMC |
| http://dx.doi.org/10.1136/bmjopen-2021-057850 | DOI Listing |
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