Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada, and Dokuz Eylul University, School of Medicine, Izmir, Turkey.
Arthritis Care Res (Hoboken). 2018 Sep;70(9):1393-1399. doi: 10.1002/acr.23465. Epub 2018 Jun 28.
Lack of response to tumor necrosis factor inhibitor (TNFi) agents is not uncommon, encountered during the treatment of axial spondyloarthritis (SpA) patients, and it can be classified as primary lack of response (PLR) or secondary lack of response (SLR). The primary aim of this study was to evaluate factors associated with TNFi failure types and their characteristics in axial SpA.
Adult axial SpA patients who were TNFi naive at the time of baseline evaluation and started receiving their first biologics for active axial disease were identified. Based on the clinical response to the first TNFi, patients were then stratified into 3 groups: PLR, SLR, and responders. Clinical, demographic, and laboratory data were collected and analyzed.
There was a total of 249 axial SpA patients in the study (70.7% male, mean ± SD age 37.3 ± 12.4 years), which included PLR (n = 62), SLR (n = 93), and responders (n = 94). PLR patients tended to be older, with a lower HLA-B27 rate, a higher percentage of nonresponder axial SpA patients, and a higher baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score compared to SLR patients or responders. In multiple regression analysis, increasing age, negative HLA-B27, higher baseline BASDAI, and treatment with the soluble TNF receptor protein were the independent predictors of PLR.
PLR accounted for nearly 40% of the TNFi failures in axial SpA patients. Older age, negative HLA-B27, higher baseline disease activity, and treatment with soluble TNF receptors were the independent predictors of the primary nonresponse to TNFi.
肿瘤坏死因子抑制剂（TNFi）治疗中轴型脊柱关节炎（SpA）患者时，常会出现无应答的情况，可分为原发性无应答（PLR）或继发性无应答（SLR）。本研究的主要目的是评估与 TNFi 治疗失败类型相关的因素及其在中轴型 SpA 中的特征。
本研究纳入了基线评估时为 TNFi 初治且开始使用首种生物制剂治疗活动性中轴疾病的成年中轴型 SpA 患者。根据首种 TNFi 的临床应答情况，患者随后分为 3 组：PLR 组、SLR 组和应答者组。收集并分析了临床、人口统计学和实验室数据。
本研究共纳入 249 例中轴型 SpA 患者（70.7%为男性，平均年龄±标准差为 37.3±12.4 岁），包括 PLR 组（n=62）、SLR 组（n=93）和应答者组（n=94）。PLR 组患者年龄较大，HLA-B27 率较低，非应答性中轴 SpA 患者比例较高，基线 Bath 强直性脊柱炎疾病活动指数（BASDAI）评分较高，与 SLR 组或应答者组相比。多因素回归分析显示，年龄增长、HLA-B27 阴性、基线 BASDAI 较高和使用可溶性 TNF 受体蛋白是 PLR 的独立预测因素。
PLR 占中轴型 SpA 患者 TNFi 治疗失败的近 40%。年龄较大、HLA-B27 阴性、基线疾病活动度较高和使用可溶性 TNF 受体治疗是 TNFi 原发性无应答的独立预测因素。
