Over Half of Patients With axSpA, IBD Achieved Clinical Remission After 12 Months of TNF Treatment

Approximately half of patients with axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) achieved clinical remission at the 12-month mark after initiating tumor necrosis factor inhibitor (TNF) therapy, according to data presented at Digestive Disease Week (DDW) 2023.¹ Adalimumab treatment and a shorter disease duration may be linked with higher odds of clinical remission in patients with axSpA. However, larger studies are needed to verify these results in addition to investigate alternative therapies for this patient population.

“The disease activity of axSpA among patients with IBD who start anti-TNF agents is poorly understood,” wrote Rahul S Dalal, MD, Gastroenterology, Brigham and Women's Hospital, and colleagues. “We sought to identify clinical factors associated with remission of axSpA after initiation of anti-TNF agents among patients with Crohn’s disease (CD) and ulcerative colitis (UC).”

A retrospective cohort study included adult patients with a confirmed IBD diagnosis, as defined by the International Classification of Diseases, 10th Revision diagnosis codes, and either ankylosing spondylitis or sacroiliitis who began treatment with TNF therapies approved for IBD between January 2012 and October 2021 at a large academic center. Patients were required to have gastroenterology and rheumatology consultations prior to initiation of TNFs.

The axSpA diagnosis was confirmed via a manual chart review of imaging reports of the spine and sacroiliac joints and human leukocyte antigen B27 (HLA-B27) testing, in addition to other clinical features of axSpA. IBD was verified using a review of imaging, endoscopy, and pathology reports.

The primary endpoint was clinical remission of axSpA, which was defined as the absence or adequate control of the pain and stiffness related to axSpA as noted in the rheumatology report at the 12-month (+/- 2) mark after TNF induction with no daily nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or oral/intravenous steroids for 30 days. When the rheumatology information was not available, the gastroenterology note was used. The secondary endpoint was the clinical remission of IBD, which was defined as the simple clinical colitis activity index (SCCAI) <2, Harvey-Bradshaw Index (HBI) <5, or no oral/intravenous steroids use for 30 days. Logistic regression examined any associations between baseline characteristics, which included the TNF agent, and clinical remission of axSpA.

A total of 82 patients with axSpA and IBD received TNF therapy, with the most prescribed being adalimumab (70%). At baseline, the median age was 41 years, 51% were male, 51% of those with HLA testing were HLA-B27 positive, and 40% had prior TNF exposure. Most (79%) with imaging had radiographic or Magnetic Resonance Imaging (MRI) evidence of axSpA, 87% had active axSpA symptoms, and 58% reported active IBD symptoms (SCCAI >2, HBI >5).

At the 12-month mark, 52% (n = 42/80) of patients in the axSpA cohort and 76% (n = 62/82) of those in the IBD cohort achieved clinical remission. Of those without active axSpA at TNF initiation, 40% (n = 4/10) developed active axSpA at 12 months. An IBD duration of <5 years (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.2-7.5) and adalimumab use (reference: all other anti-TNFs; OR 2.7, 95% CI 1.002-7.1) were linked to clinical remission of axSpA at 12 months.

References

1. ^{Dalal R, Ermann J, Carlin A, Mitri J, et al. FACTORS ASSOCIATED WITH REMISSION OF AXIAL SPONDYLOARTHRITIS AT ONE YEAR AFTER INITIATION OF ANTI-TUMOR NECROSIS FACTOR AGENTS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASES. Abstract presented at Digestive Disease Week (DDW) 2023 Annual Meeting. Chicago, IL. May 6-10, 2023.}