5 years ago

Profiling Response to TNF-Inhibitor Treatment in Axial Spondyloarthritis

Nigil Haroon, Ismail Sari, Bharath Krishnan, Mansour Alazmi, Robert D. Inman
Objectives Lack of response to TNF inhibitory (TNFi) agents is not uncommon, encountered during the treatment of axial spondyloarthritis (AxSpA) patients and can be classified as primary (PLR) or secondary (SLR) lack of response. The primary aim of this study was to evaluate factors associated with TNFi failure types and their characteristics in AxSpA. Methods Adult AxSpA patients who were TNFi naive at the time of baseline evaluation and started on their first biologics for active axial disease were identified. Based on the clinical response to the first TNFi, patients were then stratified into the three groups: PLR, SLR, and responders. Clinical, demographic and laboratory data were collected and analyzed. Results There were a total of 249 (70.7% male [M], 37.3±12.4 years of age) axial SpA patients in the study, which included PLR (n=62), SLR (n=93) and responders (n=94). PLR patients tended to be older, with a lower HLA-B27 rate, a higher percentage of nr-AxSpA patients and a higher baseline BASDAI score compared to SLR or responders. In multiple regression analysis, increasing age, negative HLA-B27, higher baseline BASDAI, and treatment with the soluble TNF receptor protein were the independent predictors of PLR. Conclusions Primary lack of response accounted nearly 40% of the TNFi failures in AxSpA patients. Older age, negative HLA-B27, higher baseline disease activity and treatment with sTNFR were the independent predictors of the primary non-response to TNFi. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23465

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