Predictors of loss of remission and disease flares in patients with axial spondyloarthritis receiving antitumor necrosis factor treatment: A retrospective study

Ennio Lubrano, Fabio Massimo Perrotta, Maria Manara, Salvatore D'Angelo, Olga Addimanda, Roberta Ramonda, Leonardo Punzi, Ignazio Olivieri, Carlo Salvarani, Antonio Marchesoni

Research output: Contribution to journalArticle

Abstract

Objective. The aim of this study was to evaluate rate and predictive factors of loss of remission and disease flare in patients with axial spondyloarthritis (axSpA) receiving antitumor necrosis factor (anti-TNF) treatment. Methods. In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria, treated with adalimumab, etanercept, or infliximab with a minimum followup of 12 months and satisfying the ASAS partial remission criteria and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease were studied. Disease flare was defined as a Bath Ankylosing Spondylitis Disease Activity Index score > 4.5 or ASDAS score > 2.5 on at least 1 occasion. Results. One hundred seventy-four patients with axSpA were studied. After a median [interquartile range (IQR)] followup of 4 years (2-6), 37 patients (21.2%) experienced a loss of remission and 28 (16.1% of the whole study group) a disease flare. Median (IQR) duration of remission in patients who lost this status was 1 year (0.625-2). Higher median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, continuous nonsteroidal antiinflammatory drug (NSAID) use, and an ASDAS-CRP ≥ 0.8 during the remission period were significantly associated with both loss of remission and disease flare. At the multivariate analysis, continuous NSAID intake (OR 4.05, 95% CI 1.4-11.74, p = 0.010) and ESR > 15 (OR 2.90, 95% CI 1.23-6.82, p = 0.015) were the only factors predictive of disease reactivation. Conclusion. In this study, loss of remission and disease flares occurred, respectively, in about 21% and 16% of the patients with axSpA who achieved a state of remission while receiving anti-TNF therapy. Residual disease activity was associated with disease reactivation.

Original languageEnglish
Pages (from-to)1541-1546
Number of pages6
JournalJournal of Rheumatology
Volume43
Issue number8
DOIs
Publication statusPublished - Aug 1 2016

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Necrosis
Retrospective Studies
Ankylosing Spondylitis
Therapeutics
Blood Sedimentation
C-Reactive Protein
Anti-Inflammatory Agents
Baths
Pharmaceutical Preparations
Multicenter Studies
Multivariate Analysis

Keywords

  • Axial spondyloarthritis
  • Disease flares
  • Remission anti-TNF-α drugs

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Medicine(all)

Cite this

Predictors of loss of remission and disease flares in patients with axial spondyloarthritis receiving antitumor necrosis factor treatment : A retrospective study. / Lubrano, Ennio; Perrotta, Fabio Massimo; Manara, Maria; D'Angelo, Salvatore; Addimanda, Olga; Ramonda, Roberta; Punzi, Leonardo; Olivieri, Ignazio; Salvarani, Carlo; Marchesoni, Antonio.

In: Journal of Rheumatology, Vol. 43, No. 8, 01.08.2016, p. 1541-1546.

Research output: Contribution to journalArticle

Lubrano, Ennio ; Perrotta, Fabio Massimo ; Manara, Maria ; D'Angelo, Salvatore ; Addimanda, Olga ; Ramonda, Roberta ; Punzi, Leonardo ; Olivieri, Ignazio ; Salvarani, Carlo ; Marchesoni, Antonio. / Predictors of loss of remission and disease flares in patients with axial spondyloarthritis receiving antitumor necrosis factor treatment : A retrospective study. In: Journal of Rheumatology. 2016 ; Vol. 43, No. 8. pp. 1541-1546.
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abstract = "Objective. The aim of this study was to evaluate rate and predictive factors of loss of remission and disease flare in patients with axial spondyloarthritis (axSpA) receiving antitumor necrosis factor (anti-TNF) treatment. Methods. In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria, treated with adalimumab, etanercept, or infliximab with a minimum followup of 12 months and satisfying the ASAS partial remission criteria and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease were studied. Disease flare was defined as a Bath Ankylosing Spondylitis Disease Activity Index score > 4.5 or ASDAS score > 2.5 on at least 1 occasion. Results. One hundred seventy-four patients with axSpA were studied. After a median [interquartile range (IQR)] followup of 4 years (2-6), 37 patients (21.2{\%}) experienced a loss of remission and 28 (16.1{\%} of the whole study group) a disease flare. Median (IQR) duration of remission in patients who lost this status was 1 year (0.625-2). Higher median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, continuous nonsteroidal antiinflammatory drug (NSAID) use, and an ASDAS-CRP ≥ 0.8 during the remission period were significantly associated with both loss of remission and disease flare. At the multivariate analysis, continuous NSAID intake (OR 4.05, 95{\%} CI 1.4-11.74, p = 0.010) and ESR > 15 (OR 2.90, 95{\%} CI 1.23-6.82, p = 0.015) were the only factors predictive of disease reactivation. Conclusion. In this study, loss of remission and disease flares occurred, respectively, in about 21{\%} and 16{\%} of the patients with axSpA who achieved a state of remission while receiving anti-TNF therapy. Residual disease activity was associated with disease reactivation.",
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T1 - Predictors of loss of remission and disease flares in patients with axial spondyloarthritis receiving antitumor necrosis factor treatment

T2 - A retrospective study

AU - Lubrano, Ennio

AU - Perrotta, Fabio Massimo

AU - Manara, Maria

AU - D'Angelo, Salvatore

AU - Addimanda, Olga

AU - Ramonda, Roberta

AU - Punzi, Leonardo

AU - Olivieri, Ignazio

AU - Salvarani, Carlo

AU - Marchesoni, Antonio

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objective. The aim of this study was to evaluate rate and predictive factors of loss of remission and disease flare in patients with axial spondyloarthritis (axSpA) receiving antitumor necrosis factor (anti-TNF) treatment. Methods. In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria, treated with adalimumab, etanercept, or infliximab with a minimum followup of 12 months and satisfying the ASAS partial remission criteria and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease were studied. Disease flare was defined as a Bath Ankylosing Spondylitis Disease Activity Index score > 4.5 or ASDAS score > 2.5 on at least 1 occasion. Results. One hundred seventy-four patients with axSpA were studied. After a median [interquartile range (IQR)] followup of 4 years (2-6), 37 patients (21.2%) experienced a loss of remission and 28 (16.1% of the whole study group) a disease flare. Median (IQR) duration of remission in patients who lost this status was 1 year (0.625-2). Higher median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, continuous nonsteroidal antiinflammatory drug (NSAID) use, and an ASDAS-CRP ≥ 0.8 during the remission period were significantly associated with both loss of remission and disease flare. At the multivariate analysis, continuous NSAID intake (OR 4.05, 95% CI 1.4-11.74, p = 0.010) and ESR > 15 (OR 2.90, 95% CI 1.23-6.82, p = 0.015) were the only factors predictive of disease reactivation. Conclusion. In this study, loss of remission and disease flares occurred, respectively, in about 21% and 16% of the patients with axSpA who achieved a state of remission while receiving anti-TNF therapy. Residual disease activity was associated with disease reactivation.

AB - Objective. The aim of this study was to evaluate rate and predictive factors of loss of remission and disease flare in patients with axial spondyloarthritis (axSpA) receiving antitumor necrosis factor (anti-TNF) treatment. Methods. In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria, treated with adalimumab, etanercept, or infliximab with a minimum followup of 12 months and satisfying the ASAS partial remission criteria and/or Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease were studied. Disease flare was defined as a Bath Ankylosing Spondylitis Disease Activity Index score > 4.5 or ASDAS score > 2.5 on at least 1 occasion. Results. One hundred seventy-four patients with axSpA were studied. After a median [interquartile range (IQR)] followup of 4 years (2-6), 37 patients (21.2%) experienced a loss of remission and 28 (16.1% of the whole study group) a disease flare. Median (IQR) duration of remission in patients who lost this status was 1 year (0.625-2). Higher median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, continuous nonsteroidal antiinflammatory drug (NSAID) use, and an ASDAS-CRP ≥ 0.8 during the remission period were significantly associated with both loss of remission and disease flare. At the multivariate analysis, continuous NSAID intake (OR 4.05, 95% CI 1.4-11.74, p = 0.010) and ESR > 15 (OR 2.90, 95% CI 1.23-6.82, p = 0.015) were the only factors predictive of disease reactivation. Conclusion. In this study, loss of remission and disease flares occurred, respectively, in about 21% and 16% of the patients with axSpA who achieved a state of remission while receiving anti-TNF therapy. Residual disease activity was associated with disease reactivation.

KW - Axial spondyloarthritis

KW - Disease flares

KW - Remission anti-TNF-α drugs

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