Early treatment response predicts remission in ankylosing spondylitis
MedWire News: Rapid response to adalimumab is the strongest predictor for subsequent long-term and sustained remission among patients with ankylosing spondylitis, study findings indicate.
Joachim Sieper (University Clinic Benjamin Franklin, Berlin, Germany) and colleagues found that patients who achieved partial remission by week 12 of adalimumab treatment were 2.5 times more likely than those who did not to maintain that response for 5 years, after adjustment for multiple confounding variables.
Similarly, those who reached a state of inactive disease by 12 weeks were 3.2 times more likely than those who did not to maintain remission for 5 years.
The findings, published in the Annals of Rheumatic Disease, arise from a post-hoc analysis of 5-year data from the Adalimumab Trial evaluating Long-term efficacy in Ankylosing Spondylitis (ATLAS).
ATLAS participants, who all had active ankylosing spondylitis, were randomly assigned to receive 40 mg adalimumab (n=208) or placebo (n=107) every other week for 24 weeks. At the end of this period, they were allowed to continue with open-label adalimumab for up to 5 years.
Sieper and team explain that the Assessment in Spondyloarthritis International Society (ASAS) recommends that patients treated with tumor necrosis factor (TNF) inhibitors such as adalimumab be evaluated for treatment response at least 12 weeks after initiation of TNF-inhibitor therapy.
However, prior to this study, the implications of early treatment response on long-term disease control had not been fully explored.
The researchers report that of the 311 patients, who received at least one dose of adalimumab, 65% completed the 5-year study, 45% achieved sustained (at least 6 months) ASAS partial remission, and 55% achieved sustained Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease.
ASAS partial remission was defined as a score of 2 or less on a scale of 0 to 10 in patient assessment of disease activity, pain, function, and inflammation.
ASDAS inactive disease was defined as a score below 1.3 in disease activity, while major improvement was defined as a decrease in the disease activity score of 2 or more points from baseline.
Among 125 patients who received 5 years of adalimumab treatment, 77% achieved partial remission and 61% achieved inactive disease.
While early remission was the strongest predictor for sustained remission, worse functional activity, a state of inactive disease, and inflammation at baseline were all marginally associated with lower likelihood for achieving long-term partial remission.
Sieper and co-researchers recorded 11.7 adverse events per 100 patient-years, which is similar with previous reports on adalimumab safety, they say.
"Determining predictors of exceptional response, such as long-term disease remission over a long period, is helpful in shaping both the doctor's and the patient's expectations for chronic treatment," they write.
"These results are in alignment with current recommendations for evaluating treatment response after at least 12 weeks of treatment."
By Laura Cowen