Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry

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TUŽIL Jan MLČOCH Tomáš JIRČÍKOVÁ Jitka ZÁVADA Jakub NEKVINDOVÁ Lucie SVOBODA Michal UHER Michal KŘÍSTKOVÁ Zlatuše VENCOVSKÝ Jiří PAVELKA Karel DOLEŽAL Tomáš

Druh Článek v odborném periodiku
Časopis / Zdroj Expert Opinion on Biological Therapy
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
www https://www.tandfonline.com/doi/full/10.1080/14712598.2020.1694900
Doi http://dx.doi.org/10.1080/14712598.2020.1694900
Klíčová slova Ankylosing spondylitis; BASDAI; ASDAS; anti-TNF; work impairment; disability; predictive power; multivariate modeling
Popis Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability. Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression. Results: 2,274 biologicals-naive patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by approximate to 2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below euro3,000 in those reaching ASDAS-CRP < 2.1. Conclusions: Low disease activity measured by ASDAS-CRP <= 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.