TNF inhibitors may improve functional status in axial spondyloarthritis
medwireNews: Tumor necrosis factor (TNF) inhibitors improve the functional status of patients with axial spondyloarthritis (axSpA), with the degree of improvement in line with disease duration and activity, real-world data suggest.
“The concept of disease remission plays a relevant role in the management of axSpA. Remission should consider different aspects of the disease such as clinical disease activity, objective inflammation and, probably, function and structural damage,” Ennio Lubrano (Universitá degli Studi del Molise, Campobasso, Italy) and colleagues write in Rheumatology and Therapy.
The investigators studied 183 axSpA patients from five Italian rheumatology centers. Of these, 156 had ankylosing spondylitis (AS) and 27 had nonradiographic axSpA. All the patients received TNF inhibitors between 2010 and 2018, with nearly half (42.6%) of patients prescribed infliximab, while the remainder received etanercept (31.7%), adalimumab (19.6%), or golimumab (6.1%).
Over a median follow-up of 3 years, 64.4% of patients had significantly improved BASFI scores, with a minimum increase from before treatment of 2 points. The percentage of patients achieving a significant improvement in BASMI scores of at least 1 point relative to baseline was 48.6%.
Logistic regression analysis revealed that improved functional outcomes on the BASFI were significantly associated with male sex and shorter disease duration, while improved BASMI outcomes were associated with these two factors plus higher erythrocyte sedimentation rate and visual analog scale pain scores at the time of TNF inhibitor initiation.
Lubrano and team also note that functional improvement directly correlated with improvement in disease activity, as evaluated by BASDAI and C-reactive protein levels, as well as being inversely correlated with disease duration.
They explain that “in patients with shorter disease duration, a great part of functional impairment is caused by inflammatory activity,” and therefore the anti-inflammatory action of TNF inhibitors may partly explain the improvement in functional status in these patients.
“Our results conﬁrm that, by acting in the early stage of disease in patients with high inﬂammatory burden, a better outcome could be obtained,” say the investigators.
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