Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK.
Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, Toronto, Canada.
Rheumatology (Oxford). 2020 Sep 1;59(9):2481-2490. doi: 10.1093/rheumatology/kez657.
While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit.
The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the 'biologic' sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state.
335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12-17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%).
Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.
虽然许多符合接受抗 TNF-α 治疗条件的 axSpA 患者在接受治疗时受益，但有些患者则不然。本研究旨在确定可改善治疗效果的可调节靶点，以及确定不太可能受益的非可调节靶点。
BSRBR-AS 是一项前瞻性队列研究，纳入了 axSpA 患者，这些患者在招募时尚未接受生物治疗。生物亚组中的患者在招募时或随访期间开始接受他们的首次抗 TNF-α 治疗。在开始治疗之前，收集了社会经济、临床和患者报告的因素信息。根据 ASAS20、ASAS40、ASDAS 缓解和达到中度/不活跃的 ASDAS 疾病状态来评估治疗效果。
335 名参与者开始了他们的首次抗 TNF-α 治疗，并在中位数为 14（四分位距 12-17）周时进行了随访。根据使用的标准，反应率在 33%至 52%之间。不利的社会经济因素、教育年限较少、非全职工作预测治疗效果较差，在所有治疗效果评估中，反应的可能性降低。合并症和心理健康状况差分别是临床和患者报告因素，与缺乏反应相关。这些模型，特别是使用 ASDAS 的模型，在预测无反应者方面表现良好（阴性预测值（NPV）为 77%）。
一些预测无反应的因素（如心理健康）是可调节的，但许多因素（如社会/经济因素）在临床中是不可调节的。然而，它们确实可以识别出那些不太可能仅从生物治疗中受益的患者。应优先关注如何让这些患者从许多患者从中受益的治疗中获益。
