Six-month response to anti-TNF drugs in axial spondylarthropathy according to the fulfillment or not of New-York criteria for ankylosing spondylitis or French recommendations for anti-TNF use. A "real life" retrospective study on 175 patients.
OBJECTIVE
To assess in clinical practice the 6-month outcome in patients with axial spondylarthropathy (SpA) treated by anti-TNF, according to the fulfillment of New-York criteria (NY) for the diagnosis of ankylosing spondylitis (AS), or agreement with French recommendations (SFR) for anti-TNF use in SpA.


METHODS
Outcome could be retrospectively assessed according to the updated ASAS score (improvement of at least 50% or two units of the BASDAI) and the percentages of patients reaching at 6 month the patient BASDAI acceptable symptoms state (PASS) of 3.5.


RESULTS
A total of 175 out of 203 patients could be retrospectively assessed at 6 month. Fifty-eight percent fulfilled the NY criteria, and 81% satisfied SFR recommendations. After 6 months of anti-TNF treatment, patients with NY criteria (NY+) met the updated ASAS outcome more often than NY- (70% versus 58%) (chi-square: 0.041): reduction of BASDAI of 2.86+/-2.18 (NY+) versus 2.48+/-2.39 (NY-) (NS). PASS of 3.5 was reached in 64% (NY+) versus 49% (NY-). ASAS outcome was met in 45%/60%/69%/88% of patients with 0/1/2/>/=3 parameters to guide physician's opinion from SFR: raised ESR or CRP was present in 66%, active enthesitis or arthritis in 49%, coxitis in 13%, active or relapsing uveitis in 11%, inflammation of sacro-iliac or spine on MRI in 12%, and worsening of articular damage in 5%.


CONCLUSIONS
The effectiveness of TNF-blockers was slightly better in patients fulfilling the NY criteria for AS or SFR recommendations, but 58% of axial SpA not fulfilling NY criteria, and 48% of patients not satisfying French recommendations also met ASAS outcome.
Rheumatology Unit, Nantes University Hospital (CHU Nantes), Place Alexis Ricordeau, 44093, Nantes Cedex 01, France.
Stéphanie
S
Gérard
Benoît
B
le Goff
Yves
Y
Maugars
Jean-Marie
JM
Berthelot
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009518:New York; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012955:Societies, Medical; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha