Background: It is recommended to target remission when treating a patient with a chronic inflammatory rheumatism. To date, drug-free (DF) remission has been poorly investigated in axial Spondyloarthritis (axSpA).
Objectives: 1/To estimate the frequency of patients in DF remission after 5 years of follow-up in a cohort of early axSpA and 2/to assess the factors associated with 5-year DF Remission.
Methods: Patients: All patients included in DESIR (DEvenir des Spondyloarthrites Indifférenciées Récentes) cohort were selected for this analysis. Definition of 5-year DF Remission: 1/all patients in ASAS partial remission and/or ASDAS<1.3 at 5 year visit and 2/ taking no disease modifying anti-rheumatic drugs (DMARDs, including synthetic and biologics) only at 5-year visit (patients could have received DMARD before the 5-year visit) and 3/ with a NSAIDs score ≤ 25 at the 5-year visit. Covariates analysed: age, gender, smoking status, body mass index, disease classification criteria (ASAS, Amor, ESSG, New York), presentation at onset (peripheral or extra-articular features), disease activity at onset (BASDAI, ASDAS-CRP, CRP, MASES, TJC or SJC), functional impairment at baseline (BASFI, HAQ-AS, BASMI), comorbidities, baseline imaging data (radiographic sacroiliitis, mSASSS, MRI sacroiliitis, spine MRI Berlin score), NSAID intake within 6 months before baseline visit and 5-year treatment intake (including DMARDs, corticoids and NSAIDs). Statistical analysis: The associations between each of these clinical factors and the 5-year DF remission were tested by logistic regression. A multivariate model was built, stepwise procedure, to identify the independent variables associated with 5-year DF remission.
Results: Of the 708 patients included in DESIR cohort, 419 were seen at the 5-year visit and 72 (17.0%) were in DF remission (50% of males, aged of 33.08 years (SD:8.0), disease duration: 1.26 years (SD: 0.72), HLA-B27 in 71%, 26.4% had a MRI sacroiliitis). Patients in 5-year DF remission had lower symptom duration (1.3 year versus 1.6 year, p=0.01) had lower disease activity (BASDAI at baseline: 30.1 versus 46.1, p<0.0001, ASDAS-CRP: 1.96 versus 2.75, p<0.0001, CRP: 3.9 versus 8.6, p=0.01) had less peripheral involvement (at least 1 enthesitis at baseline: n=33 (45.8%) versus n=226 (65.1%), p=0.002; at least 1 painful joint at baseline: n=24 (33.3%) versus n=196 (56.5%), p=0.0006) less functional impairment (HAQ-AS: 0.32 versus 0.69, p< 0.0001, BASFI: 14.3 versus 32.1, p<0.0001, BASMI: 1.98 versus 2.51, p<0.0001), and had lower NSAIDs intake at baseline (NSAIDs score: 28.2 versus 48.1, p=0.0001). Interestingly, there was no difference in sacroiliac bone marrow oedema on MRI while Berlin scores on spine MRI were lower in patients in 5-year DF remission (Berlin score mean: 0.41 versus 1.24, p=0.03). During the 5 years of follow-up, patients in 5-year DF remission received less often analgesics (n=46 (63.9%) versus n=297 (85.3%), p<0.0001) and anti-TNF (n=1 (1.4%) versus n=182 (52.5%), p<0.0001), but there was no difference in NSAID or csDMARD intake between groups until the 4-year visit. After multivariate analysis, the variables that remained associated with 5-year DF remission were lower symptom duration (OR[95%CI]=0.58[0.36-0.88], p=0.01), lower baseline ASDAS-CRP (OR[95%CI]=0.50[0.32-0.76], p=0.002) or NSAIDs score (OR[95%CI]=0.54[0.34-0.81], p=0.004) and not initiating an anti-TNF during the 5 years of follow-up (OR[95%CI]=0.029[0.00-0.14], p=0.0005).
Conclusion: DF remission is rare, 5 years after onset of axSpA. Patients with longer symptom duration, higher baseline ASDAS-CRP and NSAIDs scores were less often in DF remission, while imaging and biological data did not predict DF remission.
Disclosure of Interests: Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Vanessa Rousseau: None declared, Agnès Sommet: None declared, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Yannick Degboe: None declared, Arnaud Constantin: None declared
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