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SAT0269 The effect of biologic disease-modifying antirheumatic drugs in targeting disease remission in axial spondyloarthritis (AXSPA): a systematic literature review
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  1. A.R. Cruz-Machado1,2,
  2. S.R. Manica3,4,
  3. J.L. Silva5,
  4. F.M. Pimentel-Santos3,4,
  5. J. Tavares-Costa5,
  6. E. Vieira-Sousa1,2
  1. 1Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, CHLN, Lisbon Academic Medical Centre
  2. 2Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon
  3. 3Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental
  4. 4CEDOC, NOVA Medical School, Lisbon
  5. 5Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal

Abstract

Background The treat-to-target concept is currently recommended in axSpA management and remission is the main objective of treatment. Although consensual definitions of remission are lacking, most authors assume remission as a state of inactive disease or, alternatively, of low disease activity, as a near concept. In current practice, ASAS-Partial Remission (ASAS-PR) and ASDAS-Inactive Disease (ASDAS-ID) scores have gained wide acceptance as clinical remission-like definitions.

Objectives In this review we assessed the efficacy of different biologic disease-modifying anti-rheumatic drugs (bDMARD) in achieving ASAS-PR or/and ASDAS-ID as remission-like primary outcomes. Data from randomised controlled trials (RCT) conducted in radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) patients were included.

Methods A systematic literature review was performed using the MEDLINE database (August 17 2017) with the filters “published in the last 10 years” and “humans”. The PICO (P, population; I, intervention; C, comparison; O, outcome) concept was used to perform the analysis according to: Patients – adults (>18 years old) with r-axSpA or nr-axSpA; Intervention – any bDMARD regardless of formulation or duration; Comparison – placebo and/or any different drug; Outcomes: ASAS-PR and ASDAS-ID.

Results After screening 557 references (after de-duplication), 7 RCTs fulfilled the inclusion criteria, all concerning tumour necrosis factor inhibitors (TNFi) bDMARDs – table 1. ASAS-PR was the most commonly used remission-like definition- in 6 of the 7 trials, 1 of those as a composed measure with a magnetic resonance score. Despite different baseline populations (including r-axSpA and nr-axSpA), all these trials provide evidence of TNFi efficacy in achieving remission. The proportion of patients achieving ASAS-PR and ASDAS-ID varied between 33%–61.9% and 27.3%–55%, respectively, with a minimum and maximum follow-up periods of 28 to 254 weeks for ASAS-PR and 24 weeks to 5 years for ASDAS-ID.

Abstract SAT0269 – Table 1

- bDMARD trials addressing ASAS-PR or ASDAS-ID as primary outcomes

Conclusions Clinical trials addressing remission-like concepts as primary outcomes are scarce. ASAS-PR score was the most commonly used remission outcome. Depending on the studies, between one third to one half of patients treated with TNFi achieved ASAS-PR or ASDAS-ID. Considering nowadays aimed treatment targets, these data raise the unmet need for improved treatment options and strategies, that favour optimised remissions rates in axSpA patients.

References [1] Braun2008.

[2] Davis2008.

[3] Sieper2011.

[4] Sieper2012.

[5] Song2012.

[6] Sieper2013.

[7] van Heijde2014.

[8] van Heijde2016.

[9] Smolen2017.

Disclosure of Interest None declared

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