vendredi 29 avril 2016

Age, Disease Duration Predict Anti-TNF Use in AS

GLASGOW -- Among patients with ankylosing spondylitis, factors that were independent predictors of being treated with a tumor necrosis factor (TNF) inhibitor included age and patient global score and functional index, analysis of data from the British Society for Rheumatology (BSR) biologics register showed.

For each 5-year increase in age and disease duration, there was a 15% to 20% decrease in the likelihood of a patient receiving treatment with a TNF inhibitor, reported Gareth T. Jones, PhD, of the University of Aberdeen in Scotland.

On the Bath Ankylosing Spondylitis Global Index (BASG), for each 1-point difference there was a 21% increase in likelihood of receiving a TNF inhibitor, while on the BAS functional index (BASFI), each 1-point difference was associated with a 27% increased likelihood, both of which were statistically significant.

However, on the BAS Disease Activity Index (BASDAI), which is a central requirement in the U.K. for access to biologic therapy in ankylosing spondylitis, the odds ratio for anti-TNF treatment was not statistically significant, at 1.18, Jones said at the annual meeting of the British Society for Rheumatology (BSR) here.

"This suggests that we're treating the patient and not just the disease activity, and parallels data we have in the Scotland ankylosing spondylitis register, which suggests that in terms of quality of life, the BASFI and BASG are better predictors," he said.

"The TNF inhibitors have been around for well over a decade now, and are recommended for the treatment of ankylosing spondylitis in patients who have responded inadequately or who can't tolerate nonsteroidals. But a number of questions remain about the safety and benefits of these drugs over the long term, and also because a lot of the data are from highly selected clinical trial populations."

The aim of the current study was to characterize patients who were biologics-naïve and to examine the differences between patients starting anti-TNF therapy and those who were continuing on conventional treatment, he said.

The study population was drawn from the BSR biologics register and included 1,012 patients with ankylosing spondylitis whose median age was 50 and whose median disease duration was 8 years. Three-quarters were men.

Data in the registry include various clinical measures, patient-reported outcomes, and history of extra-articular disease features, as well as objective measures of inflammation such as C-reactive protein (CRP).

A total of 25% of patients at baseline were starting anti-TNF therapy.

A variety of factors appeared to differentiate patients starting a TNF inhibitor in a univariate analysis, including younger age (OR for each additional year 0.98, 95% CI 0.97-0.99), high levels of fatigue (OR 2.86, 95% CI 2.05-3.97), a history of uveitis (OR 1.48, 95% CI 1.06-2.06), and low mood (OR 2.76, 95% CI 2-3.79).

In addition, compared with never smokers or former smokers, current smokers were 2.5 times more likely to receive anti-TNF treatment.

Moreover, for each 1-unit increase on the BASDAI, there was a 70% increase in the likelihood of TNF inhibitor treatment in the univariate analysis. This was no longer significant on the multivariate analysis, however.

Elevated CRP also was an independent predictor (OR 1.78, 95% CI 1.12-2.83).

"We have shown in a real-world population various factors that independently predicted TNF inhibitor prescription among patients with ankylosing spondylitis, which did not include the BASDAI, which is the central tenet of the National Institute for Health and Care Excellence criteria for access to these therapies," Jones concluded.

Jones reported financial support from AbbVie, Pfizer, and UCB.

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Age, Disease Duration Predict Anti-TNF Use in AS

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