Philip J Mease1,2,3, Filip Van den Bosch4,5,6, Joachim Sieper4,5,6, Yinglin Xia4,5,6, Aileen L Pangan4,5,6, In-Ho Song4,5,6. 1. From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany. pmease@philipmease.com. 2. P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB. pmease@philipmease.com. 3. P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc. pmease@philipmease.com. 4. From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany. 5. P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB. 6. P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc.
Abstract
OBJECTIVE: To evaluate the validity of enthesitis indices in patients with peripheral spondyloarthritis (pSpA). METHODS: The ABILITY-2 study evaluated the efficacy of adalimumab (ADA) versus placebo (PBO) in patients with active pSpA over 12 weeks. Patients received open-label ADA for an additional 144 weeks. Twenty-nine enthesitis sites used in 3 enthesitis scoring systems [Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)] were assessed; discriminatory capacity and treatment response at Week 12 were calculated by standardized mean difference (SMD) and Guyatt's effect size (ES). Sites showing resolution or new-onset enthesitis from baseline to Week 12 were analyzed. RESULTS: Overall, 165 patients (ADA, n = 84; PBO, n = 81) were randomized; 143 had ≥ 1 enthesitis site at baseline. The LEI (SMD -0.73, ES -1.07) and SPARCC (SMD -0.56, ES -0.99) enthesitis indices showed higher discriminatory ability and treatment response than MASES (SMD -0.32, ES -0.81). At Week 12, among sites that were positive at baseline, significantly more (p < 0.05) showed resolution among patients treated with ADA versus PBO in the Achilles tendon (60.4% and 36.5%, respectively), medial epicondyle (73.2%, 48.7%), lateral epicondyle (80.6%, 52.8%), and iliac crest (73.5%, 47.2%). Among negative sites at baseline, significantly less (p < 0.05) new-onset enthesitis was observed with ADA versus PBO for Achilles tendon (3.6% and 10.9%, respectively), greater trochanter (3.4%, 14.4%), lateral epicondyle humerus (4.7%, 15.1%), medial femoral condyle (1.6%, 9.2%), and quadriceps insertion superior patella (1.5%, 7.0%). CONCLUSION: The LEI and SPARCC enthesitis indices showed better discriminatory capacity and treatment response in patients with pSpA versus MASES, likely because these indices contain more peripheral sites. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01064856.
RCT Entities:
OBJECTIVE: To evaluate the validity of enthesitis indices in patients with peripheral spondyloarthritis (pSpA). METHODS: The ABILITY-2 study evaluated the efficacy of adalimumab (ADA) versus placebo (PBO) in patients with active pSpA over 12 weeks. Patients received open-label ADA for an additional 144 weeks. Twenty-nine enthesitis sites used in 3 enthesitis scoring systems [Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)] were assessed; discriminatory capacity and treatment response at Week 12 were calculated by standardized mean difference (SMD) and Guyatt's effect size (ES). Sites showing resolution or new-onset enthesitis from baseline to Week 12 were analyzed. RESULTS: Overall, 165 patients (ADA, n = 84; PBO, n = 81) were randomized; 143 had ≥ 1 enthesitis site at baseline. The LEI (SMD -0.73, ES -1.07) and SPARCC (SMD -0.56, ES -0.99) enthesitis indices showed higher discriminatory ability and treatment response than MASES (SMD -0.32, ES -0.81). At Week 12, among sites that were positive at baseline, significantly more (p < 0.05) showed resolution among patients treated with ADA versus PBO in the Achilles tendon (60.4% and 36.5%, respectively), medial epicondyle (73.2%, 48.7%), lateral epicondyle (80.6%, 52.8%), and iliac crest (73.5%, 47.2%). Among negative sites at baseline, significantly less (p < 0.05) new-onset enthesitis was observed with ADA versus PBO for Achilles tendon (3.6% and 10.9%, respectively), greater trochanter (3.4%, 14.4%), lateral epicondyle humerus (4.7%, 15.1%), medial femoral condyle (1.6%, 9.2%), and quadriceps insertion superior patella (1.5%, 7.0%). CONCLUSION: The LEI and SPARCC enthesitis indices showed better discriminatory capacity and treatment response in patients with pSpA versus MASES, likely because these indices contain more peripheral sites. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01064856.
Authors: Michael J Nissen; Burkhard Möller; Adrian Ciurea; Ruediger B Mueller; Patrick Zueger; Martin Schulz; Fabiana Ganz; Almut Scherer; Eleftherios Papagiannoulis; Thomas Hügle Journal: Arthritis Res Ther Date: 2021-06-09 Impact factor: 5.156