AB0818 PREDICTORS OF REMISSION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

Abstract

BackgroundAchievement of remission is a desirable outcome in axSpA, and the identification of remission predictors may further aid in the clinical and personalised management of the disease.ObjectivesTo systematically review and summarize the predictors of remission in patients with axSpA.MethodsA comprehensive search was performed in MEDLINE, EMBASE, Cochrane CENTRAL, and 2020-2021 abstracts of ACR and the EULAR annual meetings. To identify the relevant studies, medical subject headings and keywords related to “axial spondyloarthritis”, “remission,” and “prognostic study” were used. Studies were included if: patients were diagnosed with axSpA by a physician; age ≥18 years; the study assessed the potential predictive or prognostic factors related to remission, according to any definition; and the statistical analysis included multivariable analysis. The methodological quality of the included studies was assessed using the Quality of Prognosis Studies in Systematic Reviews tool.ResultsThe systematic literature review (SLR) comprised 22 articles from 4245 citations identified in our search (Figure 1). Two studies investigated “sustained remission” (at least in 3 consecutive follow-up visits), while the others assessed “point remission” (at single points in time). The most commonly used remission criteria were Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease (14 studies) and Assessment of SpondyloArthritis international Society partial remission (ASAS-PR; 11 studies) criteria. However, other non-validated definitions, most of them including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) cut-offs, were also used. In 19 studies, subjects were treated with biological disease-modifying antirheumatic drugs (bDMARDs) with or without concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or non-steroidal anti-inflammatory drugs (NSAIDs), while in one study patients were treated with a Janus kinase inhibitor, upadacitinib. Study duration ranged from 12 weeks to 8 years. Younger age, HLA-B27 positivity, male gender, lower baseline BASDAI, lower baseline Bath Ankylosing Spondylitis Functional Index (BASFI) and treatment with tumour necrosis factor inhibitor (TNFi), were the most consistent predictors of remission. Additionally, lower baseline ASDAS-CRP, lower body mass index (BMI), shorter disease duration, TNFi naivety, and concomitant use of csDMARDs were found to be predictors of remission in two studies each. Other predictors were only found to be associated with remission in single studies, namely: higher education level, more intense morning stiffness, lower baseline total back pain score, history of peripheral arthritis, no smoking, higher pain catastrophizing, lower modified Rheumatic Disease Comorbidity Index, fulfilment of ASAS clinical arm criteria, fulfilment of European Spondyloarthropathy Study Group criteria, lower erythrocyte sedimentation rate, higher Spondyloarthritis Research Consortium of Canada magnetic resonance imaging (MRI) sacroiliac joint (SIJ) and spinal inflammation score, positive MRI of the SIJ, lower Bath Ankylosing Spondylitis Metrology Index, lower Health Assessment Questionnaire for the Spondyloarthropaties, lower global pain, lower back pain score and lower enthesitis index. Of note, contradictory data were found regarding CRP and NSAIDs usage.Figure 1.Flow chart of study selectionConclusionThirty-four predictors of remission in axSpA were identified. However, many of these predictors were only identified in one or two studies. Considering the differences in study design, particularly characteristics of the population, duration of remission and remission criteria, further well-designed studies are needed to allow generalisation of the identified predictors to the general axSpA population.AcknowledgementsWe would like to thank Kate Brunskill, librarian of University College of London, for the support and review of the search strategy.Disclosure of InterestsAna Sofia Pinto: None declared, Bayram Farisogullari: None declared, Pedro Machado Speakers bureau: Received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, Consultant of: Received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript