Tumor Necrosis Factor α Inhibition in Radiographic and Nonradiographic Axial Spondyloarthritis: Results From a Large Observational Cohort

Authors

  • Adrian Ciurea,

    Corresponding author
    1. University Hospital, Zurich, Switzerland
    • Department of Rheumatology, University Hospital Zurich, Gloriastrasse 25, CH-8091 Zurich, Switzerland. E-mail: adrian.ciurea@usz.ch

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    • Dr. Ciurea has received consulting fees, speaking fees, and/or honoraria from Pfizer, AbbVie, and Merck Sharp & Dohme (less than $10,000 each).

  • Almut Scherer,

    1. Swiss Clinical Quality Management Foundation, Zurich, Switzerland
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    • Dr. Scherer has received consulting fees, speaking fees, and/or honoraria from Pfizer (less than $10,000).

  • Pascale Exer,

    1. Praxis Rheuma-Basel, Basel, Switzerland
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  • Jürg Bernhard,

    1. Buergerspital, Solothurn, Switzerland
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  • Jean Dudler,

    1. Cantonal Hospital, Fribourg, Switzerland
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    • Dr. Dudler has received consulting fees, speaking fees, and/or honoraria from Pfizer, AbbVie, UCB, Merck Sharp & Dohme, Bristol-Myers Squibb, Novartis, Roche, Amgen, and Vifor Pharma (less than $10,000 each).

  • Brigitte Beyeler,

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    • Mrs. Beyeler is deceased.

  • Rudolf Kissling,

    1. Balgrist University Hospital, Zurich, Switzerland
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  • Daniel Stekhoven,

    1. Swiss Clinical Quality Management Foundation, Zurich, Switzerland
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  • Kaspar Rufibach,

    1. rePROstat Biostatistical Consulting and Training, Bern
    2. Hoffman- La Roche, Basel, Switzerland
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  • Giorgio Tamborrini,

    1. Bethesda Hospital, Basel, Switzerland
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  • Bettina Weiss,

    1. Balgrist University Hospital, Zurich, Switzerland
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  • Rüdiger Müller,

    1. Cantonal Hospital, St. Gallen, Switzerland
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  • Michael J. Nissen,

    1. University Hospital, Geneva, Switzerland
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    • Dr. Nissen has received consulting fees, speaking fees, and/or honoraria from Pfizer and AbbVie (less than $10,000 each).

  • Beat A. Michel,

    1. University Hospital, Zurich, Switzerland
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  • Désirée van der Heijde,

    1. Leiden University Medical Center, Leiden, The Netherlands
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    • Dr. van der Heijde has received consulting fees, speaking fees, and/or honoraria from AbbVie, Amgen, AstraZeneca, Augurex, Bristol-Myers Squibb, Celgene, Centocor, Chugai, Covagen, Daiichi Pharmaceutical, Eli Lilly, GlaxoSmithKline, Janssen Biologics, Merck, Novartis, Novo Nordisk, Otsuka, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB, and Vortex Pharma (less than $10,000 each) and is the Director of Imaging Rheumatology BV.

  • Maxime Dougados,

    1. Cochin Hospital, Paris, France
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  • Annelies Boonen,

    1. Maastricht University Medical Center, Maastricht, The Netherlands
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    • Dr. Boonen has received consulting fees, speaking fees, and/or honoraria from Pfizer, AbbVie, Amgen, UCB, and Merck (less than $10,000 each).

  • Ulrich Weber,

    1. Balgrist University Hospital, Zurich, Switzerland
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    • Dr. Weber has received honoraria from AbbVie for being a workshop convenor of the International Course on Magnetic Resonance Imaging in Spondyloarthropathy and for contributing to a slide kit on spondyloarthropathy (less than $10,000 each).

  • on behalf of the Rheumatologists of the Swiss Clinical Quality Management Program for Axial Spondyloarthritis


Abstract

Objective

To evaluate the baseline characteristics of patients with radiographic axial spondyloarthritis (SpA; ankylosing spondylitis [AS]) and patients with nonradiographic axial SpA, to investigate determinants of anti–tumor necrosis factor (anti-TNF) agent prescription on the background of a nonrestrictive reimbursement policy, and to assess the response to TNF inhibition.

Methods

We compared the characteristics of radiographic axial SpA and nonradiographic axial SpA in 1,070 patients from the Swiss Clinical Quality Management (SCQM) Cohort who fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA. By taking advantage of the situation that patients who are eligible for anti-TNF treatment are preferentially enrolled in the SCQM Cohort for patients with AS/axial SpA, we explored parameters leading to the initiation of anti-TNF treatment in single and multiple regression models and assessed treatment responses.

Results

We confirmed a similar burden of disease (as determined by self-reported disease activity, impaired function, and quality of life) in patients with nonradiographic axial SpA (n = 232) and those with radiographic axial SpA (n = 838). Patients with radiographic axial SpA had higher median levels of acute-phase reactants and higher median AS Disease Activity Scores (ASDAS; 3.2 versus 3.0). Anti-TNF treatment was initiated in 363 patients with radiographic axial SpA and 102 patients with nonradiographic axial SpA, preferentially in those with sacroiliitis on magnetic resonance imaging, peripheral arthritis, a higher C-reactive protein (CRP) level, a higher ASDAS, and a higher Bath Ankylosing Spondylitis Disease Activity Index level. The ASAS criteria for 40% improvement responses at 1 year were higher in patients with radiographic axial SpA compared with those with nonradiographic axial SpA (48.1% versus 29.6%; odds ratio [OR] 2.2, 95% confidence interval [95% CI] 1.12–4.46, P = 0.02). The difference was smaller in the subgroups of patients with elevated baseline CRP levels (51.6% in patients with radiographic axial SpA versus 38.5% in those with nonradiographic axial SpA; OR 1.7, 95% CI 0.68–4.48, P = 0.29).

Conclusion

The indications for treatment with anti-TNF agents were comparable for patients with radiographic axial SpA and those with nonradiographic axial SpA. With the exception of patients with elevated CRP levels at baseline, higher rates of response to TNF inhibition were achieved in the group of patients with radiographic axial SpA than in the group with nonradiographic axial SpA.

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