Ennio Lubrano1, Fabio Massimo Perrotta2, Maria Manara2, Salvatore D'Angelo2, Olga Addimanda2, Roberta Ramonda2, Leonardo Punzi2, Ignazio Olivieri2, Carlo Salvarani2, Antonio Marchesoni2. 1. From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO, Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy.E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F. Massimo Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; I. Olivieri, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, PhD, Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia, and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. enniolubrano@hotmail.com. 2. From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso; Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO, Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy.E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; F. Massimo Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine DIMED, University of Padua; I. Olivieri, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, PhD, Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia, and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital di Reumatologia, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO.
Abstract
OBJECTIVE: The aim of this study was to evaluate rate and predictive factors of loss of remission and disease flare in patients with axial spondyloarthritis (axSpA) receiving antitumor necrosis factor (anti-TNF) treatment. METHODS: In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria, treated with adalimumab, etanercept, or infliximab with a minimum followup of 12 months and satisfying the ASAS partial remission criteria and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease were studied. Disease flare was defined as a Bath Ankylosing Spondylitis Disease Activity Index score > 4.5 or ASDAS score > 2.5 on at least 1 occasion. RESULTS: One hundred seventy-four patients with axSpA were studied. After a median [interquartile range (IQR)] followup of 4 years (2-6), 37 patients (21.2%) experienced a loss of remission and 28 (16.1% of the whole study group) a disease flare. Median (IQR) duration of remission in patients who lost this status was 1 year (0.625-2). Higher median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, continuous nonsteroidal antiinflammatory drug (NSAID) use, and an ASDAS-CRP ≥ 0.8 during the remission period were significantly associated with both loss of remission and disease flare. At the multivariate analysis, continuous NSAID intake (OR 4.05, 95% CI 1.4-11.74, p = 0.010) and ESR > 15 (OR 2.90, 95% CI 1.23-6.82, p = 0.015) were the only factors predictive of disease reactivation. CONCLUSION: In this study, loss of remission and disease flares occurred, respectively, in about 21% and 16% of the patients with axSpA who achieved a state of remission while receiving anti-TNF therapy. Residual disease activity was associated with disease reactivation.
OBJECTIVE: The aim of this study was to evaluate rate and predictive factors of loss of remission and disease flare in patients with axial spondyloarthritis (axSpA) receiving antitumor necrosis factor (anti-TNF) treatment. METHODS: In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria, treated with adalimumab, etanercept, or infliximab with a minimum followup of 12 months and satisfying the ASAS partial remission criteria and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease were studied. Disease flare was defined as a Bath Ankylosing Spondylitis Disease Activity Index score > 4.5 or ASDAS score > 2.5 on at least 1 occasion. RESULTS: One hundred seventy-four patients with axSpA were studied. After a median [interquartile range (IQR)] followup of 4 years (2-6), 37 patients (21.2%) experienced a loss of remission and 28 (16.1% of the whole study group) a disease flare. Median (IQR) duration of remission in patients who lost this status was 1 year (0.625-2). Higher median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, continuous nonsteroidal antiinflammatory drug (NSAID) use, and an ASDAS-CRP ≥ 0.8 during the remission period were significantly associated with both loss of remission and disease flare. At the multivariate analysis, continuous NSAID intake (OR 4.05, 95% CI 1.4-11.74, p = 0.010) and ESR > 15 (OR 2.90, 95% CI 1.23-6.82, p = 0.015) were the only factors predictive of disease reactivation. CONCLUSION: In this study, loss of remission and disease flares occurred, respectively, in about 21% and 16% of the patients with axSpA who achieved a state of remission while receiving anti-TNF therapy. Residual disease activity was associated with disease reactivation.
Authors: Abdulla Watad; Hannah Rowe; Charlie Bridgewood; Dennis G McGonagle; Tobias Russell; Qiao Zhou; Lisa K Anderson; Almas Khan; Robert Dunsmuir; Peter Loughenbury; Vishal Borse; Abhay Rao; Peter A Millner; Nicola Luigi Bragazzi; Howard Amital; Richard Cuhtbert; Miriam Wittmann; Kassem Sharif; Tony Kenna; Matthew A Brown; Darren Newton Journal: Ann Rheum Dis Date: 2020-05-13 Impact factor: 27.973