Krabbe S, Glintborg B, Østergaard M, Hetland M L
a The DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE) , Center for Rheumatology and Spine Diseases, Rigshospitalet , Glostrup , Denmark.
b Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.
Scand J Rheumatol. 2019 Mar;48(2):128-132. doi: 10.1080/03009742.2018.1481225. Epub 2018 Aug 13.
To investigate whether axial spondyloarthritis (axSpA) patients with extremely poor patient-reported outcomes (PROs) at start of first tumour necrosis factor inhibitor (TNFi) treatment have poorer treatment response and shorter treatment retention than other patients.
This observational cohort study was based on the nationwide DANBIO registry. Patients with axSpA who started first TNFi during 2011-2016 were stratified according to baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI ≥ 0.0 to ≤ 4.0, > 4.0 to ≤ 5.0, > 5.0 to ≤ 6.0, > 6.0 to ≤ 7.0, > 7.0 to ≤ 8.0, > 8.0 to ≤ 9.0, and > 9.0 to ≤ 10.0). An extremely poor BASDAI was defined as BASDAI > 9.0 to ≤ 10.0. Treatment responses after 6 months [≥ 50% improvement from baseline BASDAI (BASDAI50), ≥ 40% improvement in Assessment of SpondyloArthritis international Society (ASAS40) response, and ASAS partial remission] in patients with extremely poor PROs were compared with other patients by chi-squared tests, and retention rates by log-rank tests. Similar analyses were done for Bath Ankylosing Spondylitis Functional Index (BASFI), pain score, and patient global score.
The study included 1396 patients (median age 39 years, 60% men). Patients with extremely poor baseline BASDAI [63 patients (5%)] were more often women, ever smokers, and human leucocyte antigen-B27 negative, and had higher body mass index. Response rates were poorer in patients with extremely poor BASDAI vs remaining patients (BASDAI50 19% and 41%, respectively, p < 0.001; ASAS40 16% and 35%, p = 0.002; ASAS partial remission 6% and 22%, p < 0.001). Patients with extremely poor BASDAI had lower 1 year treatment retention (51% and 68%, p < 0.001). Largely similar results were found for patients with extremely poor BASFI, pain score, and patient global score.
Patients who reported an unusually large symptom burden at baseline had poor response rates and low retention rate. In such cases, competing causes of pain should carefully be taken into account when considering treatment with TNFi.
探讨在开始首次肿瘤坏死因子抑制剂（TNFi）治疗时患者报告结局（PROs）极差的中轴型脊柱关节炎（axSpA）患者是否比其他患者的治疗反应更差且治疗持续时间更短。
这项观察性队列研究基于全国性的DANBIO注册登记。2011年至2016年期间开始首次使用TNFi的axSpA患者根据基线巴斯强直性脊柱炎疾病活动指数（BASDAI，范围为≥0.0至≤4.0、>4.0至≤5.0、>5.0至≤6.0、>6.0至≤7.0、>7.0至≤8.0、>8.0至≤9.0以及>9.0至≤10.0）进行分层。BASDAI极差定义为BASDAI>9.0至≤10.0。通过卡方检验比较PROs极差患者与其他患者在6个月后的治疗反应[相对于基线BASDAI改善≥50%（BASDAI50）、国际脊柱关节炎评估协会（ASAS）反应改善≥40%（ASAS40）以及ASAS部分缓解]，并通过对数秩检验比较治疗持续率。对巴斯强直性脊柱炎功能指数（BASFI）、疼痛评分和患者总体评分进行了类似分析。
该研究纳入了1396例患者（中位年龄39岁，60%为男性）。基线BASDAI极差的患者[63例（5%）]女性更多、曾经吸烟、人类白细胞抗原-B27阴性且体重指数更高。BASDAI极差的患者与其余患者相比，反应率更低（BASDAI50分别为19%和41%，p<0.001；ASAS40分别为16%和35%，p = 0.002；ASAS部分缓解分别为6%和22%，p<0.001）。BASDAI极差的患者1年治疗持续率更低（分别为51%和68%，p<0.001）。对于BASFI极差、疼痛评分极差和患者总体评分极差的患者，也发现了大致相似的结果。
在基线时报告症状负担异常大的患者反应率低且治疗持续率低。在这种情况下，考虑使用TNFi治疗时应仔细考虑疼痛的其他可能原因。
