Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Observational Study, Research Support, Non-U.S. Gov't
- Keywords
- ASDAS, Ankylosing spondylitis, BASDAI, anti-TNF, disability, multivariate modeling, predictive power, work impairment,
- MeSH
- Absenteeism MeSH
- Spondylitis, Ankylosing complications diagnosis drug therapy epidemiology MeSH
- Biological Products therapeutic use MeSH
- Time Factors MeSH
- Adult MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Persons with Disabilities statistics & numerical data MeSH
- Disability Evaluation MeSH
- Prognosis MeSH
- Surveys and Questionnaires MeSH
- Registries statistics & numerical data MeSH
- Severity of Illness Index MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors immunology MeSH
- Efficiency * drug effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic epidemiology MeSH
- Names of Substances
- Biological Products MeSH
- Tumor Necrosis Factor-alpha MeSH
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-naïve 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 ≈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 €3,000 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.
1st Faculty of Medicine Charles University Prague Prague Czech Republic
Department of Pharmacology Faculty of Medicine Masaryk University Brno Czech Republic
Institute of Health Economics and Technology Assessment Prague Czech Republic
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