Background In the current recommendations for ankylosing spondylitis, SSZ is considered a treatment option in patients (pts) with peripheral disease (1), although it is widely accepted, and recently confirmed (2), that TNFi is superior to SSZ.
Objectives Characterize baseline differences in pts with axSpA who received TNFi or SSZ as their 1st DMARD, and secondly, to compare the response to TNFi between pts who were DMARD naïve to those who had previously received SSZ.
Methods Data is from NOR-DMARD, a Norwegian multicentre observational study of pts receiving DMARDs. DMARD-naive pts with a clinical diagnosis of axSpA (ICD-10: M45, M46.1, M46.8 or M46.9) starting SSZ or a TNFi were included. Among the SSZ-pts, those who later switched to a TNFi were identified. Selected outcome measures were patient global, SF-6D and ASDAS, BASDAI and ASAS responses. For comparisons independent t-test, Mann-Whitney U test, and Chi-square test were used.
Results We included 181 pts receiving SSZ as their 1st DMARD, of whom 66 later switched to a TNFi, and 543 pts receiving a TNFi as 1st DMARD. Pts receiving SSZ as their 1st DMARD were younger, more often female, had shorter disease duration and more swollen joints, but had similar disease activity (table). At start of TNFi in the SSZ-switchers, disease duration and activity were similar to those who received TNFi as their 1st DMARD (except more joint swelling). Response to TNFi was similar in the two groups (table).
Conclusions The use of SSZ did not seem to delay treatment with TNFi, as disease duration and activity was similar in those receiving TNFi as 1st DMARD and those who had first received SSZ, nor did response to TNFi appear to be impaired by prior SSZ-use.
Braun J et al. Ann Rheum Dis 2011;70:896–904.
Braun J et al. J Rheumatol 2012;39:836-40.
Disclosure of Interest None Declared