Assessing the Efficacy of DMARDs in Axial Spondyloarthritis Remission

Biologic disease-modifying antirheumatic drugs (bDMARDs) may have a significant effect on axial spondyloarthritis (axSpA) remission, according to findings from a systematic review and meta-analysis published in Rheumatology.

Investigators of the present analysis conducted a literature search for data from published randomized controlled trials, including long-term extensions, on treatment outcomes in patients with radiographic and nonradiographic axSpA. The Assessment of Spondyloarthritis International Society partial remission (ASAS-PR) and/or the Ankylosing Spondylitis Disease Activity Score inactive disease (ASDAS-ID) were used as remission-like outcomes in axSpA.

Of the 155 screened references, researchers selected 30 studies for data extraction, of which 22 randomized controlled trials (17 refer to tumor necrosis factor [TNF] inhibitors, 3 to secukinumab, 1 to ixekizumab, and 1 to sarilumab) and 28 long-term extensions were included in the analysis.

With regard to TNF inhibitors, the ASAS-PR remission rates, as reported in 14 trials, varied between 16% and 62% of patients who received treatment up to 28 weeks; the achievement of remission according to the ASDAS-ID, as reported in 3 trials, varied between 24% and 40% of patients. Investigators noted that the secukinumab trials reported ASAS-PR as a remission outcome and the ixekizumab trial included data on ASDAS-ID. The remission rates with these interleukin (IL)-17A inhibitors administered for 16 weeks were between 15% and 21% and 11% and 16% for ASAS-PR and ASDAS-ID, respectively.

In a meta-analysis that included 15 of the 20 randomized controlled trials with available data on ASAS-PR score, the relative risk of achieving remission was 3.864 (95% CI, 2.937-5.085) up to 24 weeks. The number needed to treat to achieve ASAS-PR varied between 2.5 and 9.0 and 8.4 and 12.3 for TNF and IL-17A inhibitors, respectively.

Long-term extensions provided evidence for the sustained efficacy of bDMARDs in achieving remission, though long-term data concerning ixekizumab were scarce. Because of the very high heterogeneity of the extension studies, the researchers were unable to perform a meta-analysis using long-term data. They also noted that the short duration of most randomized controlled trials was one of the study limitations, along with the high variability in study design, inclusion and exclusion criteria, and patient characteristics.

“Our meta-analysis showed that bDMARDs have a clear impact in axSpA remission evaluated by ASAS-PR. Nevertheless, considering currently aimed treatment targets, these data show an unmet need for improved reporting of remission-like outcomes and treatment options favouring optimized remission rates in patients [with] axSpA,” concluded the researchers.

Disclosure: This study was supported by Novartis Pharma, Portugal. Please see the original reference for a full list of authors’ disclosures.

Reference

Cruz-Machado AR, Rodrigues-Manica S, Silva JL, et al. Effect of biologic disease-modifying anti-rheumatic drugs targeting remission in axial spondyloarthritis: systematic review and meta-analysis [published online Jul 22, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa268