scholarly journals Editorial: Shifting the Goal Posts: Treatment Recommendations for Ankylosing Spondylitis and the Newly Defined Condition of Nonradiographic Axial Spondyloarthritis

2016 ◽  
Vol 68 (2) ◽  
pp. 265-269 ◽  
Author(s):  
William J. Taylor ◽  
E. William St.Clair
Keyword(s):  
Ankylosing Spondylitis ◽  
Axial Spondyloarthritis ◽  
Treatment Recommendations ◽  
Nonradiographic Axial Spondyloarthritis

scholarly journals Tumor necrosis factor-α (TNFα) inhibitors in the treatment of nonradiographic axial spondyloarthritis: current evidence and place in therapy

2017 ◽  
Vol 9 (8) ◽  
pp. 197-210 ◽  
Author(s):  
Valeria Rios Rodriguez ◽  
Denis Poddubnyy
Keyword(s):  
Ankylosing Spondylitis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Axial Spondyloarthritis ◽  
Efficacy And Safety ◽  
Tnfα Inhibitors ◽  
Factor Α ◽  
Nonradiographic Axial Spondyloarthritis ◽  
Necrosis Factor

Nonradiographic axial spondyloarthritis (SpA) and radiographic SpA (also known as ankylosing spondylitis) are currently considered as two stages or forms of one disease (axial SpA). The treatment with tumor necrosis factor-α (TNFα) inhibitors has been authorized for years for ankylosing spondylitis. In recent years, most of the anti-TNFα agents have also been approved for the treatment of nonradiographic axial SpA by the European Medicines Agency (EMA) and similar authorities in many countries around the world (but not in the US), increasing the number of possible therapies for this indication. Data from several clinical trials have demonstrated the good efficacy and safety profiles from those anti-TNFα agents. Presently, a large number of patients achieve a satisfactory clinical control with the current therapies, however, there remains a percentage refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) and TNFα inhibitors; therefore, several new drugs are currently under investigation. In 2015, the first representative of a new class of biologics [an interleukin (IL)-17 inhibitor] secukinumab, was approved for the treatment of ankylosing spondylitis; a clinical trial in nonradiographic axial SpA is currently underway. In this review, we discuss the recent data on efficacy and safety of TNFα-inhibitors focusing on the treatment of nonradiographic axial SpA.

Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry

2016 ◽  
Vol 44 (1) ◽  
pp. 59-69 ◽  
Author(s):  
Bente Glintborg ◽  
Inge J. Sørensen ◽  
Mikkel Østergaard ◽  
Lene Dreyer ◽  
Abdiweli A. Mohamoud ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
Tumor Necrosis Factor Inhibitor ◽  
Observational Cohort Study ◽  
Hla B27 ◽  
Factor Inhibitor ◽  
Observational Cohort ◽  
Nonradiographic Axial Spondyloarthritis ◽  
Necrosis Factor

Objective.To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status).Methods.Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm].Results.The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27–negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55–84)/65 mm (48–77); global: 76 mm (62–88)/68 mm (50–80); fatigue: 74 mm (55–85)/67 mm (50–80); and BASDAI: 64 (54–77)/59 (46–71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3–17)/11 mg/l (5–22); and BAS Metrology Index: 20 (10–40)/40 (20–50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15–2.02) versus 3.67 years (2.86–4.49), p < 0.0001; but only in univariate and not confounder-adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29–2.36), AS: HR 2.04 (1.53–2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05).Conclusion.In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.

Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Part of a Common Spectrum or Distinct Diseases?

2013 ◽  
Vol 40 (12) ◽  
pp. 2038-2041 ◽  
Author(s):  
Dinny Wallis ◽  
Nigil Haroon ◽  
Renise Ayearst ◽  
Adele Carty ◽  
Robert D. Inman
Keyword(s):  
Ankylosing Spondylitis ◽  
Acute Phase ◽  
Axial Spondyloarthritis ◽  
Laboratory Data ◽  
Clinic Visit ◽  
Early Form ◽  
Acute Phase Reactants ◽  
Significant Burden ◽  
Distinct Disease ◽  
Nonradiographic Axial Spondyloarthritis

Objective.To investigate the features of ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) in a Canadian cohort of 639 patients with AS and 73 patients with nr-axSpA.Methods.Clinical and laboratory data were compared for patients with AS and nr-axSpA enrolled in a longitudinal SpA cohort.Results.The proportion of male patients was higher in AS than in nr-axSpA (76.2% vs 47.9%; p < 0.0001). There was no difference in the presence of HLA-B27 between AS (78.9%) and nr-axSpA (72.5%) patients, nor in age at the time of diagnosis, although AS patients were younger at the time of symptom onset (23.9 yrs vs 26.4 yrs; p = 0.03). Disease duration at the time of last clinic visit was longer for AS than for nr-axSpA patients (17.7 yrs vs 12.1 yrs; p = 0.0002). Acute-phase reactants were higher in AS than in nr-axSpA (C-reactive protein 11.4 vs 5.2, p < 0.0001; erythrocyte sedimentation rate 13.7 vs 9.9, p = 0.02). The Bath Ankylosing Spondylitis Metrology Index was higher in patients with AS (2.84 vs 1.35, p < 0.0001).Conclusion.Patients with nr-axSpA were more likely to be female and to have lower inflammatory markers than patients with AS. When restricted to female patients only, acute-phase reactants did not differ significantly between AS and nr-axSpA. The evidence provides indirect support for the concept that nr-axSpA may represent an early form of AS, but that also has features of a distinct disease entity with significant burden of symptoms.

scholarly journals 228. Effects of Smoking in Patients with Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis Receiving TNF Inhibitors

Rheumatology ◽  
2014 ◽  
Vol 53 (suppl_1) ◽  
pp. i145-i145
Author(s):  
Özlem Pehlivan ◽  
Yasemin Yalçınkaya ◽  
Nihat Hüseyinsinoğlu ◽  
Nilüfer Alpay Kanıtez ◽  
Bahar Artım Esen ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Axial Spondyloarthritis ◽  
Tnf Inhibitors ◽  
Nonradiographic Axial Spondyloarthritis

Tumor Necrosis Factor-α Inhibition in Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Treatment Response, Drug Survival, and Patient Outcome

2015 ◽  
Vol 42 (12) ◽  
pp. 2376-2382 ◽  
Author(s):  
Justine Corli ◽  
René-Marc Flipo ◽  
Peggy Philippe ◽  
Anne Bera-Louville ◽  
Hélène Béhal ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Axial Spondyloarthritis ◽  
Drug Survival ◽  
Baseline Characteristics ◽  
Factor Α ◽  
Nonradiographic Axial Spondyloarthritis ◽  
Necrosis Factor

Objective.The purpose of this study was to (1) evaluate baseline characteristics of nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) treated with tumor necrosis factor-α inhibitors (TNFi), (2) assess the response to first TNFi treatment, and (3) compare drug-survival duration and rates.Methods.Inclusion criteria were patients with axSpA who initiated first TNFi treatment between April 2001 and July 2014 and were followed up for at least 3 months. Efficacy criteria were an improvement of at least 2 points (on a 0–10 scale) or a 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Baseline characteristics, responses at 12 months, and drug survival were compared between AS and nr-axSpA.Results.A total of 361 patients were included in the study (AS, n = 263 and nr-axSpA, n = 98). Patients with AS were more often men (65.02% vs 45.92%, p = 0.001) and had longer symptom duration (11.71 ± 9.52 vs 7.34 ± 9.30 yrs, p < 0.001). Median levels of acute-phase reactants (C-reactive protein and erythrocyte sedimentation rate) were significantly higher in patients with AS (p < 0.001 for both). Median BASDAI scores at first TNFi initiation were not higher in patients with nr-axSpA than in patients with AS (59, 49–70 vs 60, 50–70, p = 0.73). BASDAI 20 and BASDAI 50 response rates at 12 months were not statistically different between patients with AS and patients with nr-axSpA (74.58% vs 64.58%, p = 0.19 and 61.02% vs 50.00%, p = 0.19, respectively). No statistically significant difference in terms of survival was observed between patients with AS and nr-axSpA (p = 1.00).Conclusion.Treatment response and drug survival were similar in patients with AS and nr-axSpA after first TNFi initiation.

scholarly journals Discriminating Value of Calprotectin in Disease Activity and Progression of Nonradiographic Axial Spondyloarthritis and Ankylosing Spondylitis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Jinxian Huang ◽  
Zhihua Yin ◽  
Guoxiang Song ◽  
Shengjin Cui ◽  
Jinzhao Jiang ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
Healthy Individuals ◽  
Bone Fusion ◽  
Calprotectin Level ◽  
Nonradiographic Axial Spondyloarthritis

It has been controversial whether ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) are separate or different phases of radiographic progression. We determined that serum calprotectin level (ng/ml) was higher in AS (15.30 ± 6.49) and nr-axSpA (17.76 ± 8.59) patients than in healthy individuals (7.40 ± 2.67). No difference was observed in calprotectin level between these two groups. Elevated calprotectin was positively correlated with ESR, CRP, BASDAI, and ASDAS as well as SPARCC scoring and had no correlation with BASFI and mSASSS. No correlation was observed between calprotectin and Wnt/β-catenin pathway markers. Serum calprotectin can be used as a marker for inflammation in both nr-axSpA and AS, while it does not contribute to the discrimination of AS and nr-axSpA. Calprotectin-mediated inflammation was not correlated with principle effectors of Wnt/β-catenin pathway, indicating that inflammation and bone fusion might be separate processes of the disease.

Remission in Nonradiographic Axial Spondyloarthritis Treated with Anti-tumor Necrosis Factor-α Drugs: An Italian Multicenter Study

2014 ◽  
Vol 42 (2) ◽  
pp. 258-263 ◽  
Author(s):  
Ennio Lubrano ◽  
Fabio Massimo Perrotta ◽  
Antonio Marchesoni ◽  
Salvatore D’Angelo ◽  
Roberta Ramonda ◽  
...  
Keyword(s):  
New York ◽  
Clinical Practice ◽  
Ankylosing Spondylitis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Axial Spondyloarthritis ◽  
Rank Test ◽  
Tnf Α ◽  
Nonradiographic Axial Spondyloarthritis ◽  
Necrosis Factor

Objective.To investigate the possibility of achieving partial remission (PR) in patients with nonradiographic axial spondyloarthritis (nr-axSpA) versus ankylosing spondylitis (AS) treated with anti-tumor necrosis factor (TNF)-α antagonists, such as adalimumab (ADA), etanercept (ETN), and infliximab (IFX), in a real clinical practice setting. The Assessment of SpondyloArthritis international Society (ASAS) 20, ASAS40, and Ankylosing Spondylitis Disease Activity Score were also calculated.Methods.A retrospective study was conducted in patients with axSpA treated with ADA, ETN, and IFX from 2000 to 2013. All patients fulfilled the ASAS or the modified New York criteria. PR was reached when the score was < 20 mm (on a visual analog scale of 0–100 mm) in each of these domains: (1) patient global assessment, (2) pain, (3) function, and (4) inflammation.Results.A total of 321 patients with axSpA were treated. Among them, 62 were nr-axSpA while the remaining 259 were AS. Log-rank test to compare survival curves showed that the probability of obtaining PR in nr-axSpA and AS during treatment with anti-TNF-α was not significantly different. At 12 weeks of exposure to the first anti-TNF-α drug, PR was achieved in 7 patients with nr-axSpA (11.3%) and in 68 patients with AS (26.2%).Conclusion.Our results, obtained from clinical practice, showed that PR is an achievable target of anti-TNF-α treatment in nr-axSpA. The PR rate, as a reliable indicator of sustained effectiveness, is similar in nr-axSpA and in AS.

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