Article Text
Abstract
Background: TNFα blockers have been shown to be highly efficacious in patients with active ankylosing spondylitis (AS).
Objective: To identify parameters predicting the clinical response to TNF blockers in AS.
Methods: Patients with active AS participated in two placebo controlled, randomised trials conducted in Germany with infliximab (n = 69) and etanercept (n = 30), respectively. For inclusion in either trial patients had to have high disease activity (BASDAI ⩾4) and a spinal pain score (numerical rating scale 0–10) ⩾4 despite treatment with NSAIDs. A major clinical response was defined as a 50% improvement of the initial BASDAI (BASDAI 50) after 12 weeks’ treatment with active drug. Logistic regression likelihood ratio tests (univariate and multivariate), Student’s t test, and χ2 tests were performed.
Results: Univariate analysis showed the following to be predictors of a major response (BASDAI 50) to treatment: shorter disease duration (p = 0.003); lower BASFI (p = 0.007); younger age (p = 0.009); raised ESR (p = 0.033); raised CRP (p = 0.035). After adjustment for disease duration, BASFI, ESR, and CRP, but not age, remained significantly associated. After adjustment for disease duration and for BASFI, ESR, CRP, and in addition, a higher BASDAI were significantly associated with response. The best multivariate model built by stepwise regression contained the covariables disease duration, BASFI, BASDAI, and CRP.
Conclusion: A shorter disease duration, younger age, and a lower BASFI are predictors of a major clinical response to TNF blockers in active AS. Raised CRP and a higher BASDAI may also be valuable predictors. These data need to be confirmed in further studies.
- tumour necrosis factor blockers
- ankylosing spondylitis
- spondyloarthropathies
- response
- anti-tumour necrosis factor
- AS, ankylosing spondylitis
- ASAS, Ankylosing Spondylitis Assessment Group
- BASDAI, Bath Ankylosing Spondylitis Disease Activity Index
- BASFI, Bath Ankylosing Spondylitis Functional Index
- BASMI, Bath Ankylosing Spondylitis Metrology Index
- BASRI, Bath Ankylosing Spondylitis Radiology Index
- CRP, C reactive protein
- DMARD, disease modifying antirheumatic drug
- ESR, erythrocyte sedimentation rate
- LRT, likelihood ratio test
- MRI, magnetic resonance imaging
- NSAID, non-steroidal anti-inflammatory drug
- TNFα, tumour necrosis factor α
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- tumour necrosis factor blockers
- ankylosing spondylitis
- spondyloarthropathies
- response
- anti-tumour necrosis factor
- AS, ankylosing spondylitis
- ASAS, Ankylosing Spondylitis Assessment Group
- BASDAI, Bath Ankylosing Spondylitis Disease Activity Index
- BASFI, Bath Ankylosing Spondylitis Functional Index
- BASMI, Bath Ankylosing Spondylitis Metrology Index
- BASRI, Bath Ankylosing Spondylitis Radiology Index
- CRP, C reactive protein
- DMARD, disease modifying antirheumatic drug
- ESR, erythrocyte sedimentation rate
- LRT, likelihood ratio test
- MRI, magnetic resonance imaging
- NSAID, non-steroidal anti-inflammatory drug
- TNFα, tumour necrosis factor α