Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry

Bente Glintborg; Inge J Sørensen; Mikkel Østergaard; Lene Dreyer; Abdiweli A Mohamoud; Niels S Krogh; Oliver Hendricks; Lis S Andersen; Johnny Lillelund Raun; Marcin Ryszard Kowalski; Laura Danielsen; Randi Pelck; Henrik Nordin; Jens K Pedersen; Dorte G A Kraus; Susan R Christensen; Inger Marie Jensen Hansen; Jakob Esbesen; Annette Schlemmer; Anne Gitte Loft; Nabil Al Chaer; Lone Salomonsen; Merete L Hetland

doi:10.3899/jrheum.160958

Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry

Bente Glintborg, Inge J Sørensen, Mikkel Østergaard, Lene Dreyer, Abdiweli A Mohamoud, Niels S Krogh, Oliver Hendricks, Lis S Andersen, Johnny Lillelund Raun, Marcin Ryszard Kowalski, Laura Danielsen, Randi Pelck, Henrik Nordin, Jens K Pedersen, Dorte G A Kraus, Susan R Christensen, Inger Marie Jensen Hansen, Jakob Esbesen, Annette Schlemmer, Anne Gitte LoftNabil Al Chaer, Lone Salomonsen, Merete L Hetland

Department of Clinical Medicine

21 Citations (Scopus)

Abstract

Objective. To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status). Methods. Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. Results. The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder- adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). Conclusion. In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.

Original language	English
Journal	Journal of Rheumatology
Volume	44
Issue number	1
Pages (from-to)	59-69
Number of pages	11
ISSN	0315-162X
DOIs	https://doi.org/10.3899/jrheum.160958
Publication status	Published - 1 Jan 2017

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Glintborg, B., Sørensen, I. J., Østergaard, M., Dreyer, L., Mohamoud, A. A., Krogh, N. S., Hendricks, O., Andersen, L. S., Raun, J. L., Kowalski, M. R., Danielsen, L., Pelck, R., Nordin, H., Pedersen, J. K., Kraus, D. G. A., Christensen, S. R., Hansen, I. M. J., Esbesen, J., Schlemmer, A., ... Hetland, M. L. (2017). Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry. Journal of Rheumatology, 44(1), 59-69. https://doi.org/10.3899/jrheum.160958

Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry. / Glintborg, Bente; Sørensen, Inge J; Østergaard, Mikkel et al.
In: Journal of Rheumatology, Vol. 44, No. 1, 01.01.2017, p. 59-69.

Research output: Contribution to journal › Journal article › Research › peer-review

Glintborg, B, Sørensen, IJ, Østergaard, M, Dreyer, L, Mohamoud, AA, Krogh, NS, Hendricks, O, Andersen, LS, Raun, JL, Kowalski, MR, Danielsen, L, Pelck, R, Nordin, H, Pedersen, JK, Kraus, DGA, Christensen, SR, Hansen, IMJ, Esbesen, J, Schlemmer, A, Loft, AG, Al Chaer, N, Salomonsen, L & Hetland, ML 2017, 'Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry', Journal of Rheumatology, vol. 44, no. 1, pp. 59-69. https://doi.org/10.3899/jrheum.160958

Glintborg B, Sørensen IJ, Østergaard M, Dreyer L, Mohamoud AA, Krogh NS et al. Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry. Journal of Rheumatology. 2017 Jan 1;44(1):59-69. doi: 10.3899/jrheum.160958

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title = "Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis: Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry",

abstract = "Objective. To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status). Methods. Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. Results. The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder- adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). Conclusion. In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.",

keywords = "Journal Article",

author = "Bente Glintborg and S{\o}rensen, {Inge J} and Mikkel {\O}stergaard and Lene Dreyer and Mohamoud, {Abdiweli A} and Krogh, {Niels S} and Oliver Hendricks and Andersen, {Lis S} and Raun, {Johnny Lillelund} and Kowalski, {Marcin Ryszard} and Laura Danielsen and Randi Pelck and Henrik Nordin and Pedersen, {Jens K} and Kraus, {Dorte G A} and Christensen, {Susan R} and Hansen, {Inger Marie Jensen} and Jakob Esbesen and Annette Schlemmer and Loft, {Anne Gitte} and {Al Chaer}, Nabil and Lone Salomonsen and Hetland, {Merete L}",

year = "2017",

month = jan,

day = "1",

doi = "10.3899/jrheum.160958",

language = "English",

volume = "44",

pages = "59--69",

journal = "Journal of Rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology Publishing Co. Ltd.",

number = "1",

}

TY - JOUR

T1 - Ankylosing Spondylitis versus Nonradiographic Axial Spondyloarthritis

T2 - Comparison of Tumor Necrosis Factor Inhibitor Effectiveness and Effect of HLA-B27 Status. An Observational Cohort Study from the Nationwide DANBIO Registry

AU - Glintborg, Bente

AU - Sørensen, Inge J

AU - Østergaard, Mikkel

AU - Dreyer, Lene

AU - Mohamoud, Abdiweli A

AU - Krogh, Niels S

AU - Hendricks, Oliver

AU - Andersen, Lis S

AU - Raun, Johnny Lillelund

AU - Kowalski, Marcin Ryszard

AU - Danielsen, Laura

AU - Pelck, Randi

AU - Nordin, Henrik

AU - Pedersen, Jens K

AU - Kraus, Dorte G A

AU - Christensen, Susan R

AU - Hansen, Inger Marie Jensen

AU - Esbesen, Jakob

AU - Schlemmer, Annette

AU - Loft, Anne Gitte

AU - Al Chaer, Nabil

AU - Salomonsen, Lone

AU - Hetland, Merete L

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective. To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status). Methods. Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. Results. The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder- adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). Conclusion. In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.

AB - Objective. To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status). Methods. Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. Results. The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder- adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). Conclusion. In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.

KW - Journal Article

U2 - 10.3899/jrheum.160958

DO - 10.3899/jrheum.160958

M3 - Journal article

C2 - 27909080

SN - 0315-162X

VL - 44

SP - 59

EP - 69

JO - Journal of Rheumatology

JF - Journal of Rheumatology

IS - 1

ER -