Abstract
BackgroundThe purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who nonetheless have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Its clinical impact on anti-TNF survival was also investigated.MethodsWe conducted a single-centre retrospective cohort study of AS patients having low BASDAI scores (< 4) and available ASDAS-C-reactive protein (CRP) data after 3 months of first-line anti-TNF treatment. Patients were grouped into high-ASDAS (≥ 2.1) and low-ASDAS (< 2.1) groups according to the ASDAS-CRP after 3 months of anti-TNF treatment. Their characteristics were compared. And survival analyses were carried out using Kaplan–Meier curves and log-rank test with the event being discontinuation of anti-TNF treatment due to lack/loss of efficacy.ResultsAmong 116 AS patients with low BASDAI scores after 3 months of anti-TNF treatment, 38.8% were grouped into the high-ASDAS group. The high-ASDAS group tended to have greater disease activity after 9 months of treatment (BASDAI 2.9 ± 1.1 vs. 2.3 ± 1.4, p=0.007; ASDAS-CRP 1.8 ± 0.6 vs. 1.5 ± 0.7, p=0.079; proportion of high ASDAS-CRP 27.8% vs. 13.8%, p=0.094) and greater risk of discontinuing anti-TNF treatment due to lack/loss of efficacy than the low-ASDAS group (p=0.011).ConclusionsA relatively high proportion of AS patients with low BASDAI scores had high ASDAS-CRP. These low-BASDAI/high-ASDAS-CRP patients also had a greater risk for discontinuation of anti-TNF treatment due to low/lack of efficacy than the low-ASDAS group. The use of the ASDAS-CRP alone or in addition to the BASDAI may improve the assessment of AS patients treated with anti-TNF agents.
Highlights
The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment
Several attempts have been made to develop a novel biomarker of AS disease activity and some interesting biomarkers have been identified [3, 4], composite scoring systems, namely the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) have been mainly applied when assessing AS disease activity [5, 6]
The median time to discontinuation of treatment among patients of the high-ASDAS group was 19.7 (5.5–46.1) months, while the duration of therapy for the 2 cases in the low-ASDAS group who discontinued treatment was 4.9 months and 44.8 months. In this retrospective cohort study, we found that 38.8% of patients with low BASDAI scores (< 4) after 3 months (6 weeks for infliximab) of anti-TNF treatment had high disease activity according to ASDAS-C-reactive protein (CRP) assessment (≥ 2.1)
Summary
The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Similar to the BASDAI, the ASDA S includes self-reported indices of back pain, duration of morning stiffness, peripheral joint pain/swelling, and patient global assessment of disease activity; the ASDAS includes laboratory test results, such as the C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), and each parameter is weighted, not added up as for the BASDAI [6]. The BASDAI is used to measure disease activity to initiate or maintain TNF inhibitor therapy in routine clinical practice and is a standard parameter when the cost of anti-TNF therapy for Korean AS patients is covered under the Korean National Health Insurance Service [9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
