Background: ASAS-EULAR Axial Spondyloarthritis (AxSpA) guidelines recommend that AxSpA treatment should be guided according to a pre-defined target1, following increasing evidence that persistent, uncontrolled inflammatory disease activity results in long-term damage and poor outcomes2,3. Despite this, there remains no single definition for “remission” in AxSpA.
Objectives: To identify baseline characteristics of individuals achieving AxSpA disease “remission” 6 months after initiation of biologic disease-modifying therapy (bDMARD).
Methods: A two-centre retrospective cross-sectional analysis was performed, of AxSpA patients receiving their first bDMARD at the Royal National Hospital for Rheumatic Diseases, Bath, and Norfolk and Norwich Univeristy Hospital, Norwich. AxSpA “remission” was defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <1; Bath Ankylosing Spondylitis Functional Index (BASFI) <3.8 or serum C-reactive protein (CRP) <5. A non-parametric (2-tailed Chi-Square) test was applied to identify differences in baseline characteristics which distinguished those patients achieving “remission” after 6 months bDMARD treatment from others.
Results: 538 patients were included. Sufficient BASDAI data was available for 440, CRP data for 448 and BASFI data for 354. Overall, 42 (9.5%) patients achieved BASDAI <1; 275 (61.4%) achieved CRP <5 and 206 (58.2%) achieved BASFI <3.8. The differences in baseline characteristics of individuals achieving these AxSpA “remission” outcomes compared with others are summarised in Table 1, with statistically significant results at the 95% level highlighted.
Conclusion: Our self-defined measures of BASDAI and CRP remission were most achievable in our cohort for patients with lower CRP and less functional limitation before bDMARD initiation. This may reflect remission being more achievable when treating milder disease. Functional “remission” was influenced by baseline BASMI and BASDAI in our cohort, highlighting the importance of both disease activity and pre-existing structural damage on functional outcomes. Further work could include longitudinal follow-up of outcomes in these patients to establish the relevance of targeting AxSpA remission. “BASDAI remission” was very narrowly defined in this study, and this analysis could be repeated with a more achievable target eg BASDAI <3.
References:  Van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Ds 2017; 76 (6): 978-91.
 Ramiro S, van der Heijde D, van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis 2014;73:1455–61.
 Poddubnyy D, Protopopov M, Haibel H, et al. High disease activity according tothe Ankylosing Spondylitis Disease Activity Score is associated with accelerated radiographic spinal progression in patients with early axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort. Ann Rheum Dis2016;75:2114–18.
Disclosure of Interests: Thomas Williams: None declared, Karl Gaffney Grant/research support from: Abbvie, Pfizer, Consultant for: Abbvie, Lilly, Novartis, UCB, Speakers bureau: Abbvie, Biogen, Gilead, Lilly, Novartis, UCB, Alison Wadeley: None declared, Charlotte Cavill: None declared, Mandy Freeth: None declared, Alan Brooksby: None declared, Raj Sengupta Grant/research support from: AbbVie, Celgene Corporation, Merck Sharp & Dohme, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Merck Sharp & Dohme, Novartis, Pfizer, and UCB
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