Abstract
IntroductionAnti-TNF drugs have proven to be effective against spondyloarthritis (SpA), although 30% of patients fail to respond or experience adverse events leading to treatment discontinuation. In rheumatoid arthritis, the presence of anti-drug antibodies (ADA) against the first TNF inhibitor influences the outcome after switching. Our aim was to assess whether the response to a second anti-TNF drug is related to the previous development of ADA to the first anti-TNF drug SpA patients.MethodsForty-two SpA patients began a second anti-TNF drug after failing to respond to the first anti-TNF therapy. Clinical activity was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) at baseline (at the beginning of the first and second anti-TNF therapy) and at 6 months after switching. The drug and ADA levels were measured by ELISA before each administration.ResultsAll patients were treated with anti-TNF drugs and mainly due to inefficacy were switched to a second anti-TNF drug. Eleven of 42 (26.2%) developed ADA during the first biologic treatment. At baseline, no differences in ASDAS were found in patients with or without ADA to the first anti-TNF drug (3.52 ± 1.03 without ADA vs. 3.14 ± 0.95 with ADA, p = 0.399) and to the second anti-TNF drug (3.36 ± 0.94 without ADA vs. 3.09 ± 0.91 with ADA, p = 0.466). At 6 months after switching, patients with previous ADA had lower disease activity (1.62 ± 0.93 with ADA vs. 2.79 ± 1.01 without ADA, p = 0.002) and most patients without ADA had high disease activity state by the ASDAS (25 out of 31 (80.6%) without ADA vs. 3 out of 11 (27.3%) with ADA, p = 0.002).ConclusionsIn SpA the failure to respond to the first anti-TNF drug due to the presence of ADA predicts a better clinical response to a second anti-TNF drug.
Highlights
Anti-tumour necrosis factor (TNF) drugs have proven to be effective against spondyloarthritis (SpA), 30% of patients fail to respond or experience adverse events leading to treatment discontinuation
The efficacy of anti-TNF drugs against SpA has been shown in large, randomised clinical trials [6,12,13,14,15,16], it is known that some patients fail to respond to treatment or experience adverse events necessitating treatment discontinuation [11,17]
All of these patients had axial involvement and most of them had some peripheral articular manifestation as dactylitis, enthesopathy, monoarthritis and oligoarthritis (28/42 (66.7%) SpA patients: 13 ankylosing spondylitis (AS), 10 nonradiographic axial SpA, 2 psoriatic SpA, 2 SpA related to inflammatory bowel disease (IBD) and 1 reactive arthritis
Summary
Anti-TNF drugs have proven to be effective against spondyloarthritis (SpA), 30% of patients fail to respond or experience adverse events leading to treatment discontinuation. The efficacy of anti-TNF drugs against SpA has been shown in large, randomised clinical trials [6,12,13,14,15,16], it is known that some patients fail to respond to treatment or experience adverse events necessitating treatment discontinuation [11,17]. Part of this treatment failure can be explained by the development of anti-drug antibodies (ADA) [17,18,19,20]. We analysed whether the clinical response to a second anti-TNF drug is conditioned by the development of ADA against the first anti-TNF drug in a group of SpA patients
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