The impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondyloarthritis

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dc.contributor.authorNissen, M
dc.contributor.authorDelcoigne, B
dc.contributor.authorDi Giuseppe, D
dc.contributor.authorJacobsson, L
dc.contributor.authorHetland, ML
dc.contributor.authorCiurea, A
dc.contributor.authorNekvindova, L
dc.contributor.authorIannone, F
dc.contributor.authorAkkoc, N
dc.contributor.authorSokka-Isler, T
dc.contributor.authorFagerli, KM
dc.contributor.authorSantos, MJ
dc.contributor.authorCodreanu, C
dc.contributor.authorPombo-Suarez, M
dc.contributor.authorRotar, Z
dc.contributor.authorGudbjornsson, B
dc.contributor.authorVan der Horst-Bruinsma, I
dc.contributor.authorLoft, AG
dc.contributor.authorMöller, B
dc.contributor.authorMann, H
dc.contributor.authorConti, F
dc.contributor.authorCetin, GY
dc.contributor.authorRelas, H
dc.contributor.authorMichelsen, B
dc.contributor.authorRibeiro, PA
dc.contributor.authorIonescu, R
dc.contributor.authorSanchez-Piedra, C
dc.contributor.authorTomsic, M
dc.contributor.authorGeirsson, AJ
dc.contributor.authorAskling, J
dc.contributor.authorGlintborg, B
dc.contributor.authorLindström, U
dc.date.accessioned2024-07-18T12:08:38Z
dc.date.available2024-07-18T12:08:38Z
dc.description.abstractObjectives 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.
dc.identifier.issn1462-0324
dc.identifier.other1462-0332
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/11021
dc.language.isoEnglish
dc.publisherOXFORD UNIV PRESS
dc.subjectMODIFYING ANTIRHEUMATIC DRUGS
dc.subjectANKYLOSING-SPONDYLITIS
dc.subjectRHEUMATOID-ARTHRITIS
dc.subjectPSORIATIC-ARTHRITIS
dc.subjectTREATMENT RESPONSE
dc.subjectCOMEDICATION
dc.subjectINFLIXIMAB
dc.subjectMETHOTREXATE
dc.subjectSURVIVAL
dc.titleThe impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondyloarthritis
dc.typeArticle

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