Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS

• Published in: Rheumatology (Oxford, England) Vol. 59; no. 9; pp. 2481 - 2490
• Main Authors: Macfarlane, Gary J, Pathan, Ejaz, Jones, Gareth T, Dean, Linda E
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2020
• Subjects: Adult; Biological Therapy - economics; Biological Therapy - methods; Biological Therapy - psychology; Biological Therapy - statistics & numerical data; Clinical Science; Cohort Studies; Comorbidity; Effect Modifier, Epidemiologic; Female; Humans; Male; Mental Health - statistics & numerical data; Patient Acuity; Patient Reported Outcome Measures; Patient Selection; Risk Assessment - methods; Socioeconomic Factors; Spondylitis, Ankylosing - epidemiology; Spondylitis, Ankylosing - psychology; Spondylitis, Ankylosing - therapy; Treatment Outcome; Tumor Necrosis Factor Inhibitors - administration & dosage; Tumor Necrosis Factor Inhibitors - adverse effects; United Kingdom - epidemiology; United Kingdom; treatment; anti-TNF-alpha; biologic therapy; axial spondyloarthritis; response; ankylosing spondylitis
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kez657

Abstract
Objectives
While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit.
Methods
The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the ‘biologic’ sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state.
Results
335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12–17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%).
Conclusion
Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.