Greater Baseline Symptom Burden Linked to Poorer TNFi Response Rates in axSpA

man with back pain
man with back pain
Patients who reported a greater symptom burden at the start of TNFi treatment had poor response rates and low retention rates.

Individuals with axial spondyloarthritis (axSpA) who report a large symptom burden at baseline have low retention rates and poor response rates to tumor necrosis factor inhibitor (TNFi) treatment compared with other patients with axSpA, according to a study published in the Scandinavian Journal of Rheumatology.

To assess how poor patient-reported outcomes influence the response and retention rates for TNFi treatment for patients with axSpA, this observational cohort study analyzed data from DANBIO, a Danish, nationwide, clinical quality registry. Patient-reported outcomes were assessed at baseline using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), with extremely poor BASDAI defined as >9.0 to ≤10.0. Treatment response was measured according to ≥50% improvements in BASDAI (BASDAI50), ≥40% improvement in Assessment of Spondylarthritis International Society (ASAS40) response, ASAS partial remission, Bath Ankylosing Spondylitis Functional Index (BASFI), patient global scores, and pain scores.

Data for 1396 patients were included in the study, with 63 patients (5%) considered to have extremely poor BASDAI at baseline. Response rates to TNFi treatment for these 63 patients were poorer than the response rates of the remaining patients (BASDAI50, 19% vs 41%; P <.001; ASAS40, 16% vs 35%; P =.002; ASAS partial remission, 6% vs 22%,;P <.001), and they also had lower treatment retention rates at 1 year (51% vs 68%; P <.001). Similar results were found for participants with extremely poor BASFI, patient global scores, and pain scores.

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Study investigators conclude, “Patients who reported an unusually large symptom burden at baseline had poor response rates and low retention rates. In such cases, competing causes of pain should carefully be taken into account when considering treatment with TNFi.”

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Krabbe S, Glintborg B, Østergaard M, Hetland ML. Extremely poor patient-reported outcomes are associated with lack of clinical response and decreased retention rate of tumour necrosis factor inhibitor treatment in patients with axial spondyloarthritis [published online August 13, 2018]. Scand J Rheumatol. doi:10.1080/03009742.2018.1481225