Among patients with axial spondyloarthritis (axSPA), adherence to recommendations for the initiation and continuation of anti-tumor necrosis factor blocker (TNFb) therapy is associated with improved long-term outcomes in quality of life and sick leave, according to the results of the Devenir des Spondyloarthrites Indifférenciées Récentes (DESIR) prospective cohort study (ClinicalTrials.gov identifier: NCT01648907), published in Rheumatology.
The investigators evaluated adherence to Assessment of Spondyloarthritis International Society (ASAS) 2003/2006, ASAS 2016, and European Medicines Agency (EMA) recommendations in patients with axSPA. Researchers examined recommendations for TNFb initiation, in which patients were considered adherent if they started TNFb therapy when they met the conditions for initiation or if they did not commence TNFb therapy when the conditions were not met, and for TNFb continuation, in which patients were considered adherent when they continued TNFb therapy when they met the conditions for continuation or when they discontinued TNFb therapy when the conditions were not met. They examined the effects of adherence to these recommendations on functional disability, quality of life, and sick leave days over the course of 5 years.
Of the 708 patients who were included in the study, 62.15%, 54.94%, and 47.32% were considered adherent to ASAS 2003/2006, ASAS 2016, and EMA recommendations for TNFb initiation, respectively. Adherence to ASAS 2003/2006 and ASAS 2016 recommendations for TNFb continuation was reported in 47.37% and 49.39% of patients, respectively. Based on >5 years of follow-up, improved outcomes were observed in patients who adhered to recommendations for TNFb initiation and continuation. Improved outcomes included lower Bath Ankylosing Spondylitis Functional Index scores (P <.001), higher 36-Item Short-Form Survey scores (P <.001), and fewer sick leave days (P <.001).
The investigators concluded that although <50% of patients with axSPA were treated in agreement with ASAS and EMA recommendations for initiation and continuation of TNFb therapy, adherence to such recommendations is associated with better functional outcomes and fewer days of sick leave. The authors note that this is one of the first studies to evaluate adherence to recommendations for TNFb management in patients with TNFb in daily clinical practice, emphasizing that a gap exists between the recommendations and their implementation in clinical practice.
López-Medina C, Dougados M, Collantes-Estévez E, Moltó A. Adherence to recommendations for the use of anti-tumour necrosis factor and its impact over 5 years of follow-up in axial spondyloarthritis [published online February 20, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/kex514.