Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain.
BMJ Open. 2022 Apr 29;12(4):e057850. doi: 10.1136/bmjopen-2021-057850.
To determine the frequency of sustained remission (R) or low diseas activity (LDA) in patients with axial spondyloarthritis (axSpA) undergoing long-term biological therapy and to analyse predictive factors for achieving these outcomes.
Prospective, observational cohort study.
Spanish hospital.
Patients with axSpA who initiated biological treatment between 2003 and 2017.
Assessment of demographic and clinical characteristics at the beginning of treatment and disease activity every 6 months up to a maximum of 2 years.
Disease activity was measured by Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index and C reactive protein (BASDAI&CRP). Sustained R was defined as ASDAS<1.3 and/or BASDAI <2 and normal CRP while sustained LDA was defined as ASDAS <2.1 and/or BASDAI <4 and normal CRP on at least three consecutive visits.
In total 186 patients (66.1% men and 75.3% with radiographic sacroiliitis) were included. Overall, 76.8% of patients achieved ASDAS R/LDA (R53.2%/LDA23.6%) in at least one visit. Forty per cent (R17.6%/LDA22.4%) of the patients fulfilled the sustained ASDAS R/LDA state, whereas only 30.8% maintained this status (R14.8%/LDA15.9%) according to BASDAI&CRP. In the multivariate analysis, male sex (OR=4.01), younger age at the beginning of biological therapy (OR=0.96) and an HLA*B27 positive status (OR=4.30) were associated with achieving sustained ASDAS R/LDA.
In clinical practice, around one-third of patients on biological disease-modifying antirheumatic drugs achieve a sustained R/LDA status, but these rates drop to less than one in five when targeting remission, preventing the use of the latter as a feasible target. Male sex, HLA*B27 positivity and younger age at the beginning of biological therapy are the main predictors for achieving sustained R/LDA.
确定接受长期生物治疗的轴性脊柱关节炎（axSpA）患者持续缓解（R）或低疾病活动度（LDA）的频率，并分析达到这些结果的预测因素。
前瞻性、观察性队列研究。
西班牙医院。
2003 年至 2017 年间开始接受生物治疗的 axSpA 患者。
在治疗开始时和治疗期间每 6 个月评估一次人口统计学和临床特征，最长可达 2 年。
疾病活动度通过强直性脊柱炎疾病活动评分（ASDAS）和 Bath 强直性脊柱炎疾病活动指数和 C 反应蛋白（BASDAI&CRP）进行测量。持续 R 定义为 ASDAS<1.3 和/或 BASDAI<2 和正常 CRP，持续 LDA 定义为 ASDAS<2.1 和/或 BASDAI<4 和正常 CRP，至少连续三次就诊。
共纳入 186 例患者（66.1%为男性，75.3%为放射学骶髂关节炎）。总体而言，76.8%的患者至少有一次达到 ASDAS R/LDA（R53.2%/LDA23.6%）。40%（R17.6%/LDA22.4%）的患者达到了持续的 ASDAS R/LDA 状态，而只有 30.8%（R14.8%/LDA15.9%）根据 BASDAI&CRP 维持了这种状态。多变量分析显示，男性（OR=4.01）、生物治疗开始时年龄较小（OR=0.96）和 HLA*B27 阳性状态（OR=4.30）与达到持续 ASDAS R/LDA 相关。
在临床实践中，约三分之一接受生物疾病修饰抗风湿药物治疗的患者达到持续 R/LDA 状态，但当以缓解为目标时，这一比例降至不到五分之一，从而使后者难以成为可行的目标。男性、HLA*B27 阳性和生物治疗开始时年龄较小是达到持续 R/LDA 的主要预测因素。
