Predictors of Non-Radiographic Axial Spondyloarthritis Remission With Adalimumab

For patients with non-radiographic axial spondyloarthritis (nr-axSpA) receiving adalimumab therapy, younger age, male sex, human leucocyte antigen (HLA)-B27 positivity, and higher Spondyloarthritis Research Consortium of Canada (SPARCC) magnetic resonance imaging (MRI) sacroiliac joint score at baseline, are associated with remission, according to results published in RMD Open.

The study included 673 participants with nr-axSpA who had evidence of inflammation via MRI or elevated high-sensitivity C reactive protein (hs-CRP) at screening, active disease, and an inadequate response to ≥2 nonsteroidal antiinflammatory drugs. Participants received adalimumab 40 mg every other week during a 28-week open-label lead-in period.

The researchers defined clinical remission as Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS ID; score <1.3) and Assessment of Spondyloarthritis International Society partial remission (ASAS PR; score <2 out of 10 in each of the 4 ASAS domains). They used stepwise logistic regression to identify baseline predictors of remission at week 12, and at final visit.

The results indicated that lower ASDAS, lower Bath Ankylosing Spondylitis Functional Index, more severe morning stiffness, higher SPARCC MRI sacroiliac joint score, younger age (≤45 years), male sex, and presence of HLA-B27 at baseline were all associated with achieving ASDAS ID at week 12 (P≤.005). Lower SPARCC MRI spine score at baseline was also a predictor of ASDAS ID at week 12 (P =.014).

Lower Health Assessment Questionnaire modified for the Spondyloarthropathies, higher hs-CRP level, higher SPARCC MRI sacroiliac joint score, younger age (≤45 years), and male sex at baseline were significantly associated with achieving ASAS PR at week 12 (P ≤.05). Presence of HLA-B27 also predicted ASAS PR at week 12 (P =.009).

At the final visit analysis, younger age, male sex, and positive HLA-B27 were associated with ASDAS ID and ASAS PR remission. The researchers found that the presence of or higher sacroiliac joint inflammation on MRI, lower total back pain, and normal hs-CRP were strong predictors of ASADAS ID and/or ASAS PR at the final visit analysis.

“Caution is warranted when interpreting these results, and future research examining combinations of outcome parameters may provide further insight into reliable predictors of remission in patients with active nr-axSpA,” the researchers wrote.

Reference

Sieper J, Landewé R, Magrey M, et al. Predictors of remission in patients with non-radiographic axial spondyloarthritis receiving open-level adalimumab in the ABILITY-3 study. RMD Open. 2019;5:e000917.