Clinical Features and Drug Retention of TNF Inhibitors in Older Patients with Ankylosing Spondylitis: Results from the KOBIO Registry
Tóm tắt
This study aimed to analyse the clinical features and outcomes of and reasons for discontinuing tumour necrosis factor (TNF) inhibitor therapy in older patients with ankylosing spondylitis (AS). Data were extracted from the nationwide Korean College of Rheumatology Biologics registry. Clinical variables and outcomes were compared, and drug retention rate was evaluated. Among 1524 patients with AS treated with TNF inhibitors, 306 were aged ≥ 50 years (‘older patients’). Fewer patients were male, the incidence of hypertension and diabetes was higher (all p < 0.001), and the proportion of peripheral arthritis (35.6 vs. 27.1%), Ankylosing Spondylitis Disease Activity Score‒erythrocyte sedimentation rate (4.0 ± 1.1 vs. 3.6 ± 1.0), and Bath Ankylosing Spondylitis Functional Index (4.2 ± 2.6 vs. 3.3 ± 2.5) were all higher in older patients. Although the drug retention rate was lower (log-rank p = 0.018) and lack of efficacy and adverse events were more frequent in older patients (both p < 0.001), drug retention rates were not different after propensity score matching (log-rank p = 0.23). Improvements in disease activity and manifestations were comparable between groups, except for the incidence of peripheral arthritis, which decreased significantly less in older patients over 3 and 5 years. Improvements in disease-related clinical factors and drug retention rates were not different between older and younger patients with AS receiving TNF inhibitors. However, the incidence of adverse events was higher in older patients.
Tài liệu tham khảo
Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369:1379–90.
Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390:73–84.
Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ. Global prevalence of ankylosing spondylitis. Rheumatology. 2014;53:650–7.
Van Tubergen A. The changing clinical picture and epidemiology of spondyloarthritis. Nat Rev Rheumatol. 2015;11:110.
Ward MM, Learch TJ, Gensler LS, Davis JC Jr, Reveille JD, Weisman MH. Regional radiographic damage and functional limitations in patients with ankylosing spondylitis: differences in early and late disease. Arthritis Care Res (Hoboken). 2013;65:257–65.
Exarchou S, Lie E, Lindström U, Askling J, Forsblad-d’Elia H, Turesson C, et al. Mortality in ankylosing spondylitis: results from a nationwide population-based study. Ann Rheum Dis. 2016;75:1466–72.
Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016;374:2563–74.
Carbo MJ, Spoorenberg A, Maas F, Brouwer E, Bos R, Bootsma H, et al. Ankylosing spondylitis disease activity score is related to NSAID use, especially in patients treated with TNF-α inhibitors. PLoS One. 2018;13:e0196281.
Poddubnyy D, Rudwaleit M. Adalimumab for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis–a five-year update. Expert Opin Biol Ther. 2013;13:1599–611.
Davis JC, van der Heijde DM, Braun J, Dougados M, Clegg DO, Kivitz AJ, et al. Efficacy and safety of up to 192 weeks of etanercept therapy in patients with ankylosing spondylitis. Ann Rheum Dis. 2008;67:346–52.
Braun J, Baraliakos X, Listing J, Fritz C, Alten R, Burmester G, et al. Persistent clinical efficacy and safety of anti-tumour necrosis factor α therapy with infliximab in patients with ankylosing spondylitis over 5 years: evidence for different types of response. Ann Rheum Dis. 2008;67:340–5.
Braun J, Pham T, Sieper J, Davis J, Van der Linden S, Dougados M, et al. International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis. Ann Rheum Dis. 2003;62:817–24.
Wroński J, Fiedor P. The safety profile of tumor necrosis factor inhibitors in ankylosing spondylitis: are TNF inhibitors safer than we thought? J Clin Pharm. 2019;59:445–62.
Plasencia C, Kneepkens EL, Wolbink G, Krieckaert CL, Turk S, Navarro-Compán V, et al. Comparing tapering strategy to standard dosing regimen of tumor necrosis factor inhibitors in patients with spondyloarthritis in low disease activity. J Rheumatol. 2015;42:1638–46.
Minozzi S, Bonovas S, Lytras T, Pecoraro V, González-Lorenzo M, Bastiampillai AJ, et al. Risk of infections using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis. Expert Opin Drug Saf. 2016;15:11–34.
Maas F, Spoorenberg A, Brouwer E, Bos R, Efde M, Chaudhry RN, et al. Spinal radiographic progression in patients with ankylosing spondylitis treated with TNF-α blocking therapy: a prospective longitudinal observational cohort study. PLoS One. 2015;10:e0122693.
Montilla C, Del Pino-Montes J, Collantes-Estevez E, Font P, Zarco P, Mulero J, et al. Clinical features of late-onset ankylosing spondylitis: comparison with early-onset disease. J Rheumatol. 2012;39:1008–12.
Jung SM, Kwok S-K, Ju JH, Lee S-W, Song JJ, Yoon C-H, et al. Risk factors associated with inadequate control of disease activity in elderly patients with rheumatoid arthritis: results from a nationwide KOrean College of Rheumatology BIOlogics (KOBIO) registry. PLoS One. 2018;13:e0205651.
Kim J, Koh JH, Choi SJ, Jeon CH, Kwok SK, Kim SK, et al. KOBIO, the first web-based Korean biologics registry operated with a unified platform among distinct disease entities. J Rheum Dis. 2021;28:176–82.
Linden SVD, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994;21:2286–91.
Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009;68:18–24.
Calin A, Garrett S, Whitelock H, Kennedy LG, O’hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994;21:2281–5.
Calin A, Elswood J, Edmunds L. Late onset ankylosing spondylitis–a distinct disorder? Br J Rheumatol. 1991;30:69–70.
Derakhshan MH, Goodson NJ, Packham JC, Sengupta R, Molto A, Marzo-Ortega H, et al. Increased risk of hypertension associated with spondyloarthritis disease duration: results from the ASAS-COMOSPA study. J Rheumatol. 2019;46:701–9.
Haroon NN, Paterson JM, Li P, Inman RD, Haroon N. Patients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based study. Ann Intern Med. 2015;163:409–16.
Siao WZ, Liu CH, Wang YH, Wei JC, Jong GP. Increased risk of valvular heart disease in patients with ankylosing spondylitis: a nationwide population-based longitudinal cohort study. Adv Musculoskelet Dis. 2021;13:1759720x211021676.
Kang JH, Park DJ, Lee JW, Lee KE, Wen L, Kim TJ, et al. Drug survival rates of tumor necrosis factor inhibitors in patients with rheumatoid arthritis and ankylosing spondylitis. J Korean Med Sci. 2014;29:1205–11.
Gulfe A, Kapetanovic MC, Kristensen LE. Efficacy and drug survival of anti-tumour necrosis factor-alpha therapies in patients with non-radiographic axial spondyloarthritis: an observational cohort study from Southern Sweden. Scand J Rheumatol. 2014;43:493–7.
Glintborg B, Ostergaard M, Krogh NS, Dreyer L, Kristensen HL, Hetland ML. Predictors of treatment response and drug continuation in 842 patients with ankylosing spondylitis treated with anti-tumour necrosis factor: results from 8 years’ surveillance in the Danish nationwide DANBIO registry. Ann Rheum Dis. 2010;69:2002–8.
Luc M, Gossec L, Ruyssen-Witrand A, Salliot C, Duclos M, Guignard S, et al. C-reactive protein predicts tumor necrosis factor-alpha blocker retention rate in axial ankylosing spondylitis. J Rheumatol. 2007;34:2078–81.
Favalli EG, Selmi C, Becciolini A, Biggioggero M, Ariani A, Santilli D, et al. Eight-year retention rate of first-line tumor necrosis factor inhibitors in spondyloarthritis: a multicenter retrospective analysis. Arthritis Care Res (Hoboken). 2017;69:867–74.
Kim HA, Lee SK, Oh S, Park EH, Park YB, Shin K. Comparison of retention rates between tumor necrosis factor-α inhibitors in patients with ankylosing spondylitis: data from the Korean College of Rheumatology Biologics Registry. Front Med. 2021;8:689609.
Griffiths H, Smith T, Mack C, Leadbetter J, Butcher B, Acar M, et al. Persistence to biologic therapy among patients with ankylosing spondylitis: an observational study using the OPAL dataset. J Rheumatol. 2022;49:150–6.