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Where we are in treat to target era? Predictive factors for remission and drug switching in patients with axial spondyloarthritis: a real-life evidence from BioStaR nationwide registry

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Abstract

Objectives

Factors associated with disease activity of axial spondyloarthritis (axSpA) and switching of biologic disease-modifying anti-rheumatic drugs have not been clearly defined. We aimed to evaluate clinical characteristics of patients with axSpA, factors related to remission in treat to target era and predictive factors for biologic disease-modifying anti-rheumatic drug switching.

Method

A multicenter, observational cross-sectional study was performed between February 2019 and August 2019. We included all consecutive patients ≥ 18 years with axSpA. Demographic and clinical variables were prospectively recorded. Clinical tools included Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES).

Results

There were 969 patients with a mean age of 43.4 ± 10.8 years. There were 143 patients (14.8%) with remission and 223 (23.1%) patients with low disease activity. Male sex (p = 0.021), positive family history (p = 0.036), and human leukocyte antigen-B27 (p = 0.011) were predictors of remission by ASDAS-CRP. There were 654 patients (67.5%) who did not switch to another drug. The highest BASMI and MASES scores were calculated in patients with very high disease activity (p < 0.05). In patients with drug switching, the disease duration was significantly higher (p < 0.001) and the age at diagnosis was significantly lower (p = 0.016). There were significantly more patients with uveitis and higher scores of MASES and BASMI in patients who switch to another biologic disease-modifying anti-rheumatic drugs (p = 0.003, p = 0.009, and p = 0.004, respectively).

Conclusions

In patients with axSpA, male sex, younger age, and HLA-B27 positivity are associated with remission, while longer disease duration and accompanied uveitis appear to be related with drug switching.

Clinical trial registration number and date

NCT04139954/25.10.2019.

Key Points

• Achievement of remission and/or low disease activity rates in patients with axSpA were assessed in a big registry from a real-life data.

• Predictive factors for switching to another bDMARD were evaluated in axSpA patients.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey

    Hatice Bodur & Fatma Gul Yurdakul

  2. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey

    Sebnem Ataman

  3. Department of Rheumatology, Antalya Education and Research Hospital, Saglik Bilimleri University, Antalya, Turkey

    Hasan Fatih Cay

  4. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydin, Turkey

    Gulcan Gurer

  5. Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey

    Erhan Capkin

  6. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey

    İlhan Sezer

  7. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey

    Mehmet Tuncay Duruoz

  8. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ataturk University School of Medicine, Erzurum, Turkey

    Meltem Alkan Melikoglu

  9. Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, Istanbul, Turkey

    Aylin Rezvani

  10. Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey

    Ilker Yagci

  11. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey

    Feride Gogus

  12. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Sakarya University School of Medicine, Sakarya, Turkey

    Ayhan Kamanli

  13. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Manisa Celal Bayar University School of Medicine, Manisa, Turkey

    Ozgur Akgul

  14. Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakir, Turkey

    Remzi Cevik

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  1. Hatice Bodur
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Correspondence to Fatma Gul Yurdakul.

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Bodur, H., Yurdakul, F.G., Ataman, S. et al. Where we are in treat to target era? Predictive factors for remission and drug switching in patients with axial spondyloarthritis: a real-life evidence from BioStaR nationwide registry. Clin Rheumatol 41, 2053–2063 (2022). https://doi.org/10.1007/s10067-022-06145-8

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