[ACR22] Spondyloarthritis II – Therapeutic

Author: Jean-Guillaume Letarouilly

Baraliakos et al. (0420) studied the differences in the velocity and magnitude of NSAID response velocity in patients with established bDMARD naïve axSpA versus patients with other, non-inflammatory reasons of back pain. The generally proposed better and faster response of axSpA patients to treatment with high doses of NSAIDs as compared with non inflammatory back pain was not confirmed (an overall proportion of 27%-30% of patients showing improvement). All other subanalyses did not reveal any differences between axSpA patients and other non-inflammatory reasons of back pain.

Rudwaleit et al. (0543) aimed to evaluate the relationship between objective signs of inflammation and clinical outcomes following 12 weeks of certolizumab (CZP) treatment in axSpA patients. 136 patients (76 radiographic axSpA and 60 non-radiographic axSpA) were included. Following CZP treatment, CRP (100%), ASspiMRI Berlin score (53,7%), and MRI SPARCC SIJ score (52.2%) were reduced by >50% whereas only a minority of axSpA patients showed a >50% reduction in clinical responses (BASDAI: 47.1%; ASDAS: 48.5%) revealing a potential disconnect between objective signs of inflammation and clinical outcomes responses.

Deodhar et al. (0544) presented the results of the phase 3 study (BE MOBILE 1) assessing Bimekizumab (anti-IL17 A/F mab) in non-radiographic AxSpA versus placebo. At week 16, the primary endpoint  was met (ASAS40: 47.7% BKZ vs 21.4% PBO; p< 0.001).

Jones et al. (1510) collected the data of 16,696 axSpA patients starting their first TNFi treatment via the European Spondyloarthritis Research Collaboration Network. Non-smoking (OR = 0.77; 95%CI 0.68-0.86) and normal BMI (0.76; 95%CI 0.66-0.87) were associated with substantial decreases in the odds of TNFi response after 1 year of treatment.

Ogdie et al. (1600) compared clinical outcomes between PsA patients who initiated a TNFi vs a non-TNFi biologic after discontinuing a 1st line TNFi. The 2 groups presented similar results but suggest that switching to a different MOA may lead to comparable or better outcomes vs cycling among TNFi (RR=1,8; 95%CI 0.9-3.1).

Baraliakos et al. (L15) presented the results of the phase 3 head-to-head study (SURPASS) in radiographic AxSpA, that compared the effect of secukinumab (SEC) vs adalimumab (ADA) on spinal radiographic progression. Overall, 859 pts received SEC 150 mg (n=287), 300 mg (n=286), or ADA 40 mg (n=286). At week 104, the proportion of pts with no radiographic progression was  similar between the three groups, 66.1%, 66.9%, and 65.6% in secukinumab 150 mg, 300 mg, and adalimumab arms, respectively.

About the Author

Jean-Guillaume Letarouilly


Jean-Guillaume is a fellow in the department of rheumatology at Lille University Hospital, Lille, France. He is also doing a PhD student in the MABLab at Lille University focused on the effect of tofacitinib on adipose and bone tissues in rheumatoid arthritis. Aside from his PhD, his major interests are spondyloarthritis and the crosstalk between spondyloarthritis, psoriasis and inflammatory bowel diseases. Jean-Guillaume is a member of the Social Media Sub-Committee.

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