title: Primary inefficacy of TNF inhibitors in patients with axial spondyloarthritis: a long-term follow-up of 25 patients.
abstract: Primary inefficacy of TNF inhibitors (TNFi) for axial spondyloarthritis (axSpA) is infrequent. The objective of this study was to assess the long-term evolution and final diagnosis of patients with primary inefficacy of TNFi for axSpA.
  
  
  
  This was a systematic retrospective study of all patients receiving a TNFi for axSpA in one tertiary referral centre. Patients had axSpA confirmed by a rheumatologist and were started on a first course of TNFi according to usual practice. If the rheumatologist interrupted treatment at 3 months for inefficacy, this was defined as primary inefficacy. Five to 10 years later, these patients were re-evaluated.
  
  
  
  Of 222 patients receiving a first TNFi for axSpA, 27 (12%) were considered as having primary inefficacy. These patients were more often females (48 vs 27%, P = 0.04), had higher functional impairment [BASDAI (0-100) 68 vs 42, P = 0.001] and less increased CRP (50 vs 78%, P = 0.008.) At the follow-up, 25 (92%) patients were re-evaluated: the diagnosis of axSpA was confirmed for 21/25 (84%) patients according to the Assessment of SpondyloArthritis criteria and 20/25 (80%) patients according to the rheumatologist; but 18/25 (72%) had at least one other cause of their symptoms from among OA, widespread pain syndrome or depression. A second TNFi was prescribed for 16 patients and was efficacious for 9 (56%).
  
  
  
  Most patients with primary inefficacy had a confirmed diagnosis of axSpA, but they often had other causes of pain. We suggest that patients with primary inefficacy to TNFi should be screened for comorbidities that may interfere with axSpA activity assessment.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique.|Department of Rheumatology B, Cochin Hospital, Assistance Publique - Hopitaux de Paris.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kossi
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique.|Department of Rheumatology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dadoun
authors.affiliation: Paris Descartes University, Univ Paris 05, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris- Cité, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique.
authors.forename: Aurore
authors.initials: A
authors.lastname: Hermet
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique.|Department of Rheumatology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: Department of Rheumatology B, Cochin Hospital, Assistance Publique - Hopitaux de Paris.|Paris Descartes University, Univ Paris 05, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris- Cité, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique.|Department of Rheumatology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001368:Axis, Cervical Vertebra; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D025241:Spondylarthritis / Q000175:diagnosis / Q000188:drug therapy*; D017211:Treatment Failure; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: TNF inhibitors; classification criteria; diagnosis; spondyloarthritis; widespread pain syndrome