Browsing by Author "Akkoc N."
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Item Genome-wide association study in Turkish and Iranian populations identify rare familial Mediterranean fever gene (MEFV) polymorphisms associated with ankylosing spondylitis(Public Library of Science, 2019) Li Z.; Akar S.; Yarkan H.; Lee S.K.; Çetin P.; Can G.; Kenar G.; Çapa F.; Pamuk O.N.; Pehlivan Y.; Cremin K.; de Guzman E.; Harris J.; Wheeler L.; Jamshidi A.; Vojdanian M.; Farhadi E.; Ahmadzadeh N.; Yüce Z.; Dalkılıç E.; Solmaz D.; Akın B.; Dönmez S.; Sarı İ.; Leo P.J.; Kenna T.J.; Önen F.; Mahmoudi M.; Brown M.A.; Akkoc N.Ankylosing spondylitis (AS) is a highly heritable immune-mediated arthritis common in Turkish and Iranian populations. Familial Mediterranean Fever (FMF) is an autosomal recessive autoinflammatory disease most common in people of Mediterranean origin. MEFV, an FMF-associated gene, is also a candidate gene for AS. We aimed to identify AS susceptibility loci and also examine the association between MEFV and AS in Turkish and Iranian cohorts. We performed genome-wide association studies in 1001 Turkish AS patients and 1011 Turkish controls, and 479 Iranian AS patients and 830 Iranian controls. Serum IL-1β, IL-17 and IL-23 cytokine levels were quantified in Turkish samples. An association of major effect was observed with a novel rare coding variant in MEFV in the Turkish cohort (rs61752717, M694V, OR = 5.3, P = 7.63×10−12), Iranian cohort (OR = 2.9, P = 0.042), and combined dataset (OR = 5.1, P = 1.65×10−13). 99.6% of Turkish AS cases, and 96% of those carrying MEFV rs61752717 variants, did not have FMF. In Turkish subjects, the association of rs61752717 was particularly strong in HLA-B27-negative cases (OR = 7.8, P = 8.93×10−15), but also positive in HLA-B27-positive cases (OR = 4.3, P = 7.69×10−8). Serum IL-1β, IL-17 and IL-23 levels were higher in AS cases than controls. Among AS cases, serum IL-1β and IL-23 levels were increased in MEFV 694V carriers compared with non-carriers. Our data suggest that FMF and AS have overlapping aetiopathogenic mechanisms. Functionally important MEFV mutations, such as M694V, lead to dysregulated inflammasome function and excessive IL-1β function. As IL-1 inhibition is effective in FMF, AS cases carrying FMF-associated MEFV variants may benefit from such therapy. © 2019 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Item Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis(BMJ Publishing Group, 2019) Kiltz U.; Landewé R.B.M.; Van Der Heijde D.; Rudwaleit M.; Weisman M.H.; Akkoc N.; Boonen A.; Brandt J.; Carron P.; Dougados M.; Gossec L.; Jongkees M.; MacHado P.M.; Marzo-Ortega H.; Molto A.; Navarro-Compán V.; Niederman K.; Sampaio-Barros P.D.; Slobodin G.; Van Den Bosch F.E.; Van Tubergen A.; Van Weely S.; Wiek D.; Braun J.Objectives The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. Methods An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. Results The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. Conclusions ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Item Is Axial Spondyloarthritis More Common Than Rheumatoid Arthritis?(Springer, 2020) Akkoc N.; Khan M.A.Purpose of Review: To discuss the disease incidence and prevalence rates of axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS) relative to those of rheumatoid arthritis (RA). Recent Findings: According to the most recently published systematic reviews, pooled prevalence estimates for RA are 0.38% in North America, and 0.21 to 0.25% in European subregions, while that of AS is 0.20% in North America and 0.25% in Europe. The estimated prevalence of axSpA has been reported to be approximately twice as common as AS in a study from the USA. This finding has also been supported by studies from northern Norway, central Italy, western Turkey, northern and southern regions of China, and rural Taiwan. These data suggest that axSpA, that encompasses AS, may be more prevalent than RA, at least in some countries. Summary: In general, higher occurrences of RA relative to AS have been noted worldwide, both in terms of incidence and prevalence. But axSpA, that encompasses AS, may be more prevalent than RA, at least in some countries. There is a need for concurrently run studies in the same population for a reliable comparison to establish occurrence of RA, AS, and axSpA. It is hoped that the implementation of the ICD-11 codes for axSpA will be helpful in determining a more accurate estimate of its incidence and prevalence. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.Item Polygenic Risk Scores have high diagnostic capacity in ankylosing spondylitis(BMJ Publishing Group, 2021) Li Z.; Wu X.; Leo P.J.; De Guzman E.; Akkoc N.; Breban M.; MacFarlane G.J.; Mahmoudi M.; Marzo-Ortega H.; Anderson L.K.; Wheeler L.; Chou C.-T.; Harrison A.A.; Stebbings S.; Jones G.T.; Bang S.-Y.; Wang G.; Jamshidi A.; Farhadi E.; Song J.; Lin L.; Li M.; Wei J.C.-C.; Martin N.G.; Wright M.J.; Lee M.; Wang Y.; Zhan J.; Zhang J.-S.; Wang X.; Jin Z.-B.; Weisman M.H.; Gensler L.S.; Ward M.M.; Rahbar M.H.; Diekman L.; Kim T.-H.; Reveille J.D.; Wordsworth B.P.; Xu H.; Brown M.A.Objective We sought to test the hypothesis that Polygenic Risk Scores (PRSs) have strong capacity to discriminate cases of ankylosing spondylitis (AS) from healthy controls and individuals in the community with chronic back pain. Methods PRSs were developed and validated in individuals of European and East Asian ethnicity, using data from genome-wide association studies in 15 585 AS cases and 20 452 controls. The discriminatory values of PRSs in these populations were compared with other widely used diagnostic tests, including C-reactive protein (CRP), HLA-B27 and sacroiliac MRI. Results In people of European descent, PRS had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.924. This was significantly better than for HLA-B27 testing alone (AUC=0.869), MRI (AUC=0.885) or C-reactive protein (AUC=0.700). PRS developed and validated in individuals of East Asian descent performed similarly (AUC=0.948). Assuming a prior probability of AS of 10% such as in patients with chronic back pain under 45 years of age, compared with HLA-B27 testing alone, PRS provides higher positive values for 35% of patients and negative predictive values for 67.5% of patients. For PRS, in people of European descent, the maximum positive predictive value was 78.2% and negative predictive value was 100%, whereas for HLA-B27, these values were 51.9% and 97.9%, respectively. Conclusions PRS have higher discriminatory capacity for AS than CRP, sacroiliac MRI or HLA-B27 status alone. For optimal performance, PRS should be developed for use in the specific ethnic groups to which they are to be applied. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Item Pseudoscience at the expense of rheumatic disease patients during the Coronavirus disease 2019 pandemic(Clinical and Experimental Rheumatology S.A.S., 2021) Akkoc N.[No abstract available]Item JAK Inhibitors for Axial Spondyloarthritis: What does the Future Hold?(Springer, 2021) Akkoc N.; Khan M.A.Purpose of Review: To discuss the potential role of JAK inhibitors (JAKis) as a new therapeutic class for the treatment of axial spondyloarthritis (axSpA, including ankylosing spondylitis [AS] and non-radiographic axSpA [nr-axSpA]). Recent Findings: A phase III randomized controlled trial of tofacitinib (a “pan JAKi”) in patients with active AS was found to be superior to placebo in achieving the ASAS20 primary endpoint at week 16 (56.4% and 29.4%, p < 0.0001, phase II trials of AS). Upadacitinib, a JAK1 inhibitor, has also been evaluated in a phase III trial for its efficacy and safety in AS. The primary endpoint, ASAS40 at week 16, was reached by 52% of the patients randomized to upadacitinib and 26% of the patients receiving placebo (p = 0·0003). All the important secondary endpoints also improved with both agents. No new changes in their safety profile were noted. However, the more frequent occurrence of cardiovascular and cancer adverse events associated with tofacitinib than with TNFi observed in the very recent post-marketing “ORAL surveillance” safety study, the results of which were released on January 27, 2021, may lead to safety concerns swirling around the whole class of JAKis. Summary: JAKis seem to be effective in treating signs and symptoms of AS but have not been studied in nr-axSpA. Both tofacitinib and upadacitinib have been pre-registered with the FDA for the treatment of AS. Upadacitinib has just recently received approval for this indication in the European Union. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.Item Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association study(Cell Press, 2021) Ortiz-Fernández L.; Saruhan-Direskeneli G.; Alibaz-Oner F.; Kaymaz-Tahra S.; Coit P.; Kong X.; Kiprianos A.P.; Maughan R.T.; Aydin S.Z.; Aksu K.; Keser G.; Kamali S.; Inanc M.; Springer J.; Akar S.; Onen F.; Akkoc N.; Khalidi N.A.; Koening C.; Karadag O.; Kiraz S.; Forbess L.; Langford C.A.; McAlear C.A.; Ozbalkan Z.; Yavuz S.; Çetin G.Y.; Alpay-Kanitez N.; Chung S.; Ates A.; Karaaslan Y.; McKinnon-Maksimowicz K.; Monach P.A.; Ozer H.T.E.; Seyahi E.; Fresko I.; Cefle A.; Seo P.; Warrington K.J.; Ozturk M.A.; Ytterberg S.R.; Cobankara V.; Onat A.M.; Duzgun N.; Bıcakcıgil M.; Yentür S.P.; Lally L.; Manfredi A.A.; Baldissera E.; Erken E.; Yazici A.; Kısacık B.; Kaşifoğlu T.; Dalkilic E.; Cuthbertson D.; Pagnoux C.; Sreih A.; Reales G.; Wallace C.; Wren J.D.; Cunninghame-Graham D.S.; Vyse T.J.; Sun Y.; Chen H.; Grayson P.C.; Tombetti E.; Jiang L.; Mason J.C.; Merkel P.A.; Direskeneli H.; Sawalha A.H.Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 × 10−5) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets. © 2020 American Society of Human GeneticsItem Assessing rheumatologists’ attitudes and utilization of classification criteria for ankylosing spondylitis and axial spondyloarthritis: a global effort(Springer Science and Business Media Deutschland GmbH, 2021) Rich-Garg N.; Danve A.; Choi D.; Vakil-Gilani K.; Akkoc N.; Azevedo V.; Russell A.; Sharma A.; Cush J.; Curtis J.R.; Deodhar A.Objectives: This study aims to assess rheumatologists’ perceptions, utilization patterns, and attitudes towards the modified New York (mNY) criteria for ankylosing spondylitis (AS) and Assessment of SpondyloArthritis International Society (ASAS) criteria for axial spondyloarthritis (axSpA). Methods: Members of the national rheumatology societies in five countries (United States of America (USA), Canada, India, Turkey, and Brazil) were invited to participate in a survey containing questions regarding rheumatologists’ familiarity, and use of AS and axSpA classification criteria in daily practice, perceived specificity of spondyloarthritis features in making the diagnosis, patterns of imaging tests performed in daily practice, and their opinion about the need for modification of current classification criteria. The responses were analyzed by gender, age, years in practice, as well as by country of practice. Descriptive statistics, t test, and chi-square test were used for comparison of groups. Results: Approximately 6% rheumatologists (478 out of 8021 professional association members) from five countries completed the survey. The country-specific response rates were Brazil 4%, USA 4.3%, India 11%, Canada 14%, and Turkey 29%, though the overall contributions from individual countries were USA 47%, India 14.9%, Brazil 13.8%, Turkey 12.8%, and Canada 8.8%. The mean age of respondents was 50 years (± 11.8), 31% were females and 90% spent majority (> 75%) of their time in clinical practice. The mNY and ASAS criteria were regularly used in clinical practice by 44 and 66% of responders, respectively. Those reporting “always” using ASAS criteria were more likely to be women (p = 0.006), and within 5 years of completing rheumatology training. Vast majority (74%) regarded Inflammatory Back Pain (IBP) as a specific feature for axSpA. Majority (50 and 60%, respectively) regarded uveitis and dactylitis as “very specific” features helping them make the diagnosis of axSpA, whereas heel enthesitis, peripheral inflammatory arthritis, and response to NSAIDs were considered “somewhat specific” by 50% of the responders. Less than half (47%) of the responders used the mNY grading for X-ray of SI joints. In the case of normal X-ray of SI joint, the use of MRI was more frequent than CT scan (83.6 vs. 10.9%) in assessing for sacroiliitis. If sacroiliitis was not seen on X-rays, the likelihood of ordering MRI was significantly higher among rheumatologists completing training within < 15 years versus > 25 years prior (90 vs. 75%, p = 0.007). Overall, 70% thought that ASAS criteria were adequately specific for clinical trials. However, 42% respondents still felt a need to modify ASAS classification criteria for axSpA. Also, 46% respondents felt that mNY criteria should be modified. Conclusions: In the absence of diagnostic criteria, majority of rheumatologists are using the classification criteria for diagnosis of axSpA. Though axSpA classification criteria are perceived to be specific for clinical trials, 40% rheumatologists feel the need to modify these criteria.Key Points• This study informs how rheumatologists in five countries spread over four different continents diagnose axSpA in clinical practice.• Since majority rheumatologists among survey respondents across the countries use ASAS criteria for diagnosis of axSpA, more specific criteria may be required to avoid overdiagnosis.• MRI is commonly used to rule out sacroiliitis in case of normal X-ray of sacroiliac joints. © 2020, International League of Associations for Rheumatology (ILAR).Item Do mobility exercises in different environments have different effects in ankylosing spondylitis?(Sociedade Portuguesa de Reumatologia, 2021) Gurpinar B.; Ilcin N.; Savci S.; Akkoc N.Aims: Ankylosing spondylitis (AS) reduces spinal mobility, which results in structural and functional impairments. Pulmonary problems eventually occur in most AS patients due to interstitial lung disease or as a result of chest wall abnormalities. The aim of this study was to evaluate the effects on pulmonary functions and disease related scales of aquatic and land-based multidimensional functional mobility exercises on pulmonary functions in patients with AS. Methods: In this randomized controlled study, 57 patients with definite AS according to the modified New York criteria were randomly allocated to an aquatic (AG), land-based (LG), or home (HG) exercise group and performed multidimensional mobility exercise sessions twice a week for 8 weeks. The Bath indices were used to measure disease activity, functional limitation, and spinal mobility, and a 10-cm visual analog scale assessed pain during activity and at rest. Pulmonary function tests, maximal inspiratory mouth pressure (MIP), and maximal expiratory mouth pressure (MEP) were measured before and after the intervention. The study is registered at ClinicalTrials.gov, number NCT03667625 (27/08/2018). Results: Forty-six patients (30.4% female) with a mean age of 42.0 years completed the study. Multidimensional exercises improved disease-related symptoms such as pain, spinal mobility, and functionality, but there were no significant changes in HG. Patients in AG showed significant improvements in peak expiratory flow (p=0.004), vital capacity (p=0.025), maximum voluntary ventilation (p=0.006), and MIP (p=0.001), while those in LG showed significant increases in forced expiratory volume during the first second to forced vital capacity (FEV1/FVC) ratio (p=0.049), peak expiratory flow (p=0.007), and maximum voluntary ventilation (p=0.004). There were no significant changes in HG. Conclusions: Multidimensional functional mobility exercises performed either in water or on land are important in the management of pulmonary manifestations of AS © 2021,Acta Reumatologica Portuguesa.All Rights ReservedItem Predictors of ASDAS-CRP inactive disease in axial spondyloarthritis during treatment with TNF-inhibitors: Data from the EuroSpA collaboration(W.B. Saunders, 2022) Ørnbjerg L.M.; Linde L.; Georgiadis S.; Rasmussen S.H.; Lindström U.; Askling J.; Michelsen B.; Giuseppe D.D.; Wallman J.K.; Pavelka K.; Závada J.; Nissen M.J.; Jones G.T.; Relas H.; Pirilä L.; Tomšič M.; Rotar Z.; Geirsson A.J.; Gudbjornsson B.; Kristianslund E.K.; van sder Horst-Bruinsma I.; Loft A.G.; Laas K.; Iannone F.; Corrado A.; Ciurea A.; Santos M.J.; Santos H.; Codreanu C.; Akkoc N.; Gunduz O.S.; Glintborg B.; Østergaard M.; Hetland M.L.Objectives: In patients with axial spondyloarthritis (axSpA) initiating their first tumor necrosis factor alpha-inhibitor (TNFi), we aimed to identify common baseline predictors of Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP) inactive disease (primary objective) and clinically important improvement (CII) at 6 months, and drug retention at 12-months across 15 European registries. Methods: Baseline demographic and clinical characteristics were collected. Outcomes were investigated per registry and in pooled data using logistic regression analyses on multiply imputed data. Results: The consistency of baseline predictors in individual registries justified pooling the data. In the pooled dataset (n = 21,196), the 6-month rates for ASDAS inactive disease and ASDAS CII were 26% and 51%, and the 12-month drug retention rate 65% in patients with available data (n = 9,845, n = 6,948 and n = 21,196, respectively). Nine common baseline predictors of ASDAS inactive disease, ASDAS CII and 12-month drug retention were identified, and the odds ratios (95%-confidence interval) for ASDAS inactive disease were: age, per year: 0.97 (0.97–0.98), men vs. women: 1.88 (1.60–2.22), current vs. non-smoking: 0.76 (0.63–0.91), HLA-B27 positive vs. negative: 1.51 (1.20–1.91), TNF start year 2015–2018 vs. 2009–2014: 1.24 (1.06–1.45), CRP>10 vs. ≤10 mg/l: 1.49 (1.25–1.77), one unit increase in health assessment questionnaire (HAQ): 0.77 (0.58–1.03), one-millimeter (mm) increase in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) fatigue and spinal pain: 0.99 (0.99–1.00) and 0.99 (0.99–1.99), respectively Conclusion: Common baseline predictors of treatment response and adherence to TNFi could be identified across data from 15 European registries, indicating that they may be universal across different axSpA populations. © 2022Item European bio-naïve spondyloarthritis patients initiating TNF inhibitor: Time trends in baseline characteristics, treatment retention and response(Oxford University Press, 2022) Christiansen S.N.; Ørnbjerg L.M.; Rasmussen S.H.; Loft A.G.; Askling J.; Iannone F.; Zavada J.; Michelsen B.; Nissen M.; Onen F.; Santos M.J.; Pombo-Suarez M.; Relas H.; Macfarlane G.J.; Tomsic M.; Codreanu C.; Gudbjornsson B.; Van Der Horst-Bruinsma I.; Di Giuseppe D.; Glintborg B.; Gremese E.; Pavelka K.; Kristianslund E.K.; Ciurea A.; Akkoc N.; Barcelos A.; Sánchez-Piedra C.; Peltomaa R.; Jones G.T.; Rotar Z.; Ionescu R.; Grondal G.; Van De Sande M.G.H.; Laas K.; Østergaard M.; Hetland M.L.Objectives: To investigate time trends in baseline characteristics and retention, remission and response rates in bio-naïve axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients initiating TNF inhibitor (TNFi) treatment. Methods: Prospectively collected data on bio-naïve axSpA and PsA patients from routine care in 15 European countries were pooled. Three cohorts were defined according to year of TNFi initiation: A (1999-2008), B (2009-2014) and C (2015-2018). Retention, remission and response rates were assessed at 6, 12 and 24 months. Results: In total, 27 149 axSpA and 17 446 PsA patients were included. Cohort A patients had longer disease duration compared with B and C. In axSpA, cohort A had the largest proportion of male and HLA-B27 positive patients. In PsA, baseline disease activity was highest in cohort A. Retention rates in axSpA/PsA were highest in cohort A and differed only slightly between B and C. For all cohorts, disease activity decreased markedly from 0 to 6 months. In axSpA, disease activity at 24 months was highest in cohort A, where also remission and response rates were lowest. In PsA, remission rates at 6 and 12 months tended to be lowest in cohort A. Response rates were at all time points comparable across cohorts, and less between-cohort disease activity differences were seen at 24 months. Conclusion: Our findings indicate that over the past decades, clinicians have implemented more aggressive treatment strategies in spondyloarthritis. This was illustrated by shorter disease duration at treatment initiation, decreased retention rates and higher remission rates during recent years. © 2021 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.Item The impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondyloarthritis(Oxford University Press, 2022) Nissen M.; Delcoigne B.; Di Giuseppe D.; Jacobsson L.; Hetland M.L.; Ciurea A.; Nekvindova L.; Iannone F.; Akkoc N.; Sokka-Isler T.; Fagerli K.M.; Santos M.J.; Codreanu C.; Pombo-Suarez M.; Rotar Z.; Gudbjornsson B.; Van Der Horst-Bruinsma I.; Loft A.G.; Moller B.; Mann H.; Conti F.; Yildirim Cetin G.; Relas H.; Michelsen B.; Avila Ribeiro P.; Ionescu R.; Sanchez-Piedra C.; Tomsic M.; Geirsson A.J.; Askling J.; Glintborg B.; Lindstrom U.Objectives: Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. Methods: Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP < 1.3 and/or BASDAI < 2) and stratified by treatment. Inter-registry heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Peripheral arthritis was defined as ≥1 swollen joint at baseline (=TNFi start). Results: Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P < 0.001). Remission was obtained in 20% on monotherapy and 22% on co-therapy (P < 0.001); adjusted OR of 1.16 (1.07, 1.25). Remission rates at 12 months were similar in patients with/without peripheral arthritis. Conclusion: This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy. © 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.Item Corrigendum to ‘Predictors of ASDAS-CRP inactive disease in axial spondyloarthritis during treatment with TNF-inhibitors: data from the EuroSpA collaboration’ [Seminars in Arthritis and Rheumatism 56 (2022) 1-13/152081] (Seminars in Arthritis and Rheumatism (2022) 56, (S0049017222001329), (10.1016/j.semarthrit.2022.152081))(W.B. Saunders, 2023) Ørnbjerg L.M.; Linde L.; Georgiadis S.; Rasmussen S.H.; Lindström U.; Askling J.; Michelsen B.; Giuseppe D.D.; Wallman J.K.; Pavelka K.; Závada J.; Nissen M.J.; Jones G.T.; Relas H.; Pirilä L.; Tomšič M.; Rotar Z.; Geirsson A.J.; Gudbjornsson B.; Kristianslund E.K.; van der Horst-Bruinsma I.; Loft A.G.; Laas K.; Iannone F.; Corrado A.; Ciurea A.; Santos M.J.; Santos H.; Codreanu C.; Akkoc N.; Gunduz O.S.; Glintborg B.; Østergaard M.; Hetland M.L.The authors regret that the following incorrect values have been published in the original paper: In the abstract: Line 11-12: “age, per year: 0.97 (0.97-0.98)” should be “age, per year: 0.98 (0.97-0.99)” Line 12: “men vs. women: 1.88 (1.60-2.22)” should be “men vs. women: 1.79 (1.51-2.12)” Line 12: “current vs. non-smoking: 0.76 (0.63-0.91)” should be “current vs. non-smoking: 0.72 (0.59-0.87)” Line 12-13: “HLA-B27 positive vs. negative: 1.51 (1.20-1.91)” should be “HLA-B27 positive vs. negative: 1.65 (1.27-2.15)” Line 14: “CRP>10 vs. ≤10 mg/l: 1.49 (1.25-1.77)” should be “CRP>10 vs. ≤10 mg/l: 1.36 (1.14-1.62)” Line 15-16: “fatigue and spinal pain: 0.99 (0.99-1.00) and 0.99 (0.99-1.99)” should be “fatigue and spinal pain: 0.99 (0.99-0.99) and 0.99 (0.99-1.00)” In Table 3, row with EPV (row 3 after header/subheader): Column with header/subheader “Czech Republic/ATTRA”: EPV 15.9 should be 13.2 Column with header/subheader “Netherlands/ARC”: EPV 1 should be 1.0 Column with header/subheader “Portugal/Reuma.pt”: EPV 14.7 should be 13.1 Column with header/subheader “Romania/RRBR”: EPV 2.8 should be 2.4 Column with header/subheader “Turkey/TURKBIO”: EPV 12.9 should be 11.8 In Table 5, row with “Patient global score, mm” (row 10 counting from row with “Age at treatment start, years”): In the column with header: “Analysis of 12-month drug retention” and subheader: “Univariate”, the value for the odds ratio (OR) is missing. The OR should be 0.99. The authors would like to apologise for any inconvenience caused. © 2022 The AuthorsItem Assessing safety and efficacy of TNFi treatment in late onset ankylosing spondylitis: a TURKBIO registry study(Nature Research, 2024) Uslu S.; Gulle S.; Sen G.; Cefle A.; Yilmaz S.; Kocaer S.B.; Yuce Inel T.; Koca S.S.; Yolbas S.; Ozturk M.A.; Senel S.; Inanc N.; Dalkilic H.E.; Soysal Gunduz O.; Tufan A.; Akar S.; Birlik A.M.; Sari I.; Akkoc N.; Onen F.Clinical data on the use of tumour necrosis factor inhibitors (TNFi) in late-onset ankylosing spondylitis (LoAS) are limited. The present study aimed to evaluate efficacy, safety, and treatment adherence associated with the initial use of TNFi therapy in biologic naive patients diagnosed with LoAS. Patients whose age of onset was ≥ 45 years and < 45 years were classified as having LoAS and YoAS, respectively, based on the age of symptom onset. There were 2573 patients with YoAS and 281 LoAS. Baseline disease activity measures were similar between the groups. No significant differences were seen between the two groups in response to treatment and in remaining on the first TNFi at 6, 12 and 24 months. In the LoAS group, the analysis showed that TNFi discontinuation was linked to VAS pain score (HR 1.04; 95% CI 1.01–1.06). Patient groups had similar rates of adverse events (YoAS: 8.7% vs. LoAS: 11.7%). In both biologic naive LoAS and YoAS patients, the study showed that the initial TNFi therapy was equally effective and safe. © The Author(s) 2024.Item Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry(Oxford University Press, 2024) Karakaş A.; Gulle S.; Can G.; Dalklllc E.; Akar S.; Koca S.S.; Pehlivan Y.; Senel S.; Tufan A.; Ozturk M.A.; Yilmaz S.; Yazici A.; Cefle A.; Yüce Inel T.; Erez Y.; Sari I.; Birlik M.; Direskeneli H.; Akkoc N.; Onen F.Objectives: The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS). Methods: We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated. Results: There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P =. 003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P >. 05). Conclusions: This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients. © 2023 Japan College of Rheumatology. Published by Oxford University Press. All rights reserved.