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 M.L.
dc.contributor.authorCiurea A.
dc.contributor.authorNekvindova L.
dc.contributor.authorIannone F.
dc.contributor.authorAkkoc N.
dc.contributor.authorSokka-Isler T.
dc.contributor.authorFagerli K.M.
dc.contributor.authorSantos M.J.
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 A.G.
dc.contributor.authorMoller B.
dc.contributor.authorMann H.
dc.contributor.authorConti F.
dc.contributor.authorYildirim Cetin G.
dc.contributor.authorRelas H.
dc.contributor.authorMichelsen B.
dc.contributor.authorAvila Ribeiro P.
dc.contributor.authorIonescu R.
dc.contributor.authorSanchez-Piedra C.
dc.contributor.authorTomsic M.
dc.contributor.authorGeirsson A.J.
dc.contributor.authorAskling J.
dc.contributor.authorGlintborg B.
dc.contributor.authorLindstrom U.
dc.date.accessioned2024-07-22T08:03:46Z
dc.date.available2024-07-22T08:03:46Z
dc.date.issued2022
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. © 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
dc.identifier.DOI-ID10.1093/rheumatology/keac174
dc.identifier.issn14620324
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/12439
dc.language.isoEnglish
dc.publisherOxford University Press
dc.rightsAll Open Access; Green Open Access
dc.subjectAntirheumatic Agents
dc.subjectAxial Spondyloarthritis
dc.subjectHumans
dc.subjectSpondylarthritis
dc.subjectTreatment Outcome
dc.subjectTumor Necrosis Factor Inhibitors
dc.subjectTumor Necrosis Factor-alpha
dc.subjectadalimumab
dc.subjectcertolizumab pegol
dc.subjectdisease modifying antirheumatic drug
dc.subjectetanercept
dc.subjectgolimumab
dc.subjectinfliximab
dc.subjectleflunomide
dc.subjectmethotrexate
dc.subjectsalazosulfapyridine
dc.subjecttumor necrosis factor inhibitor
dc.subjectantirheumatic agent
dc.subjecttumor necrosis factor
dc.subjecttumor necrosis factor inhibitor
dc.subjectadult
dc.subjectAnkylosing Spondylitis Disease Activity Score
dc.subjectArticle
dc.subjectaxial spondyloarthritis
dc.subjectBath ankylosing spondylitis disease activity index
dc.subjectcontrolled study
dc.subjectdisease activity score
dc.subjectdisease duration
dc.subjectdrug retention
dc.subjectfemale
dc.subjectfollow up
dc.subjecthuman
dc.subjectjoint swelling
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmonotherapy
dc.subjectobservational study
dc.subjectoutcome assessment
dc.subjectremission
dc.subjecttreatment outcome
dc.subjectspondylarthritis
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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