TNFi Therapy May Benefit Patients With Lower Levels of AS Disease Activity

TNFi treatment was initiated in nearly one-third of patients with a BASDAI level lower than the recommended cutoff.

Treatment with tumor necrosis factor inhibitors (TNFi) may be beneficial for patients with ankylosing spondylitis (AS) whose disease activity level is lower than the currently recommended Bath Ankylosing Spondylitis Disease Index (BASDAI) cutoff, according to results published in The Journal of Rheumatology.

International recommendations for the management of AS recommend a BASDAI level of disease activity of ≥4 to initiate biologic treatment. However, the results of the current study showed that patients with scores of 2.8 to <4 also had significant benefit from TNFi initiation.

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The post hoc analysis included participants with AS who had not previously been treated with biologic drugs who were treated with golimumab 50 mg subcutaneously once every month (n=244). The researchers sought to evaluate the level of disease activity used to initiate TNFi treatment as well as the level of response to treatment based on different BASDAI cutoffs.

At baseline, 70.5% of participants had a BASDAI level ≥4 (group 1), 14.3% had scores 2.8 to <4 (group 2), and 15.1% had scores <2.8 (group 3). Of these, 54.9% (n=134) of participants completed the 24-month observational period.

At baseline, the mean BASDAI score was 5.9±1.3 in group 1, 3.4±0.4 in group 2, and 2.0±0.8 in group 3. Within 3 months, the mean BASDAI score in groups 1, 2, and 3 were 2.2±2.0, 1.9±1.2, and 1.0±1.2, respectively (all P <.0001). At 24 months, the mean BASDAI score in groups 1, 2, and 3 decreased to 2.2±1.7, 1.9±1.7, and 1.4±1.0, respectively (all P <.005).

At 3 months, BASDAI 50% improvement occurred in 68.8% of participants in group 1, 44.8% in group 2, and 45.2% in group 3. At 24 months, BASDAI 50% improvement occurred in 84.9% of participants in group 1, 61.9% in group 2, and 55.0% in group 3.

“This finding may lead to a re-evaluation of the established BASDAI cut-off of ≥4,” the researchers wrote.


Braun J, Baraliakos X, Kiltz U, et al. Rheumatologists use different cut offs for disease activity in real life – the experience with golimumab in ankylosing spondylitis – subanalysis from the non-interventional German GO-NICE study [published online March 18, 2019]. J Rheumatol. doi:10.3899/jrheum.181040