Background Anti-TNF-α agents are the mainstay of pharmacotherapy for patients with axial spondyloarthritis (AxSpA) who failed treatment with NSAIDs. A little is known about the influence of early versus delayed treatment initiation on their clinical efficacy.
Objectives To compare change of disease activity in AxSpA patients on anti-TNF-α therapy based on symptom duration prior to treatment initiation.
Methods Baseline demographic data and efficacy parameters of patients starting their first anti-TNF-α treatment ≤10 years (EARLY) or >10 years (DEALYED) after first symptoms of AxSpA from the Czech national registry ATTRA were compared. Mean ±SD and absolute/relative frequencies were used to describe continuous and categorical variables, respectively. P-value of Fisher‘s exact test and Mann-Whitney test is given when assessing difference between groups in categorical and continuous variables. ATTRA is a centralised prospective computerised registry of patients receiving bDMARD therapy for rheumatic diseases collecting data on efficacy, safety and quality of life of all patients treated in the Czech Republic. Anti-TNF-α therapy was indicated for patients with AxSpA who have failed treatment with NSAIDs with CRP ≥1 mg/dl and BASDAI score ≥4.
Results Data from 1290 axSpA patients were available for analysis. 618 patients started treatment ≤10 years (EARLY) and 672>10 years (DELAYED) after the onset of AxSpA symptoms. There was no significant difference in gender distribution (71.4 vs 72.5% males; p=0.67) or age at AxSpA diagnosis (33.3±10.4 vs 33.5±10.4; p=0.68) between the two groups. At the time of anti-TNF-α initiation EARLY patients were significantly younger (36.4±10.6 vs 44.0±11.2 years; p<0.001) with shorter symptom duration (5.5±2.7 vs 18.9±8.1; p<0.001), but disease activity assessed by BASDAI (6.3±1.8 vs 6.3±1.6; p=0.81) and serum CRP levels (2.6±2.5 vs 2.4±2.0 mg/dL; p=0.34) were comparable in both groups. Mean change of BASDAI scores from baseline during anti-TNF-α therapy was significantly greater in the EARLY group at all time-points (3.7±2.5 vs 3.4±2.2 at month 3, 4.2±2.5 vs 3.8±2.3 at month 6, 4.4±2.5 vs 4.0±2.3 at month 12 and 4.4±2.5 vs 4.0±2.4 at month 24; p<0,05 for all) suggesting better treatment response. The difference in survival on therapy between the two groups was not statistically significant.
Conclusions AxSpA patients starting anti-TNF-α therapy more than 10 years after onset of symptoms have significantly worse response to treatment compared to patients with earlier treatment initiation.
Acknowledgements This study was supported by the project of MHCR for conceptual development of research organisation 00023728
Disclosure of Interest None declared
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