Axial spondyloarthritis and response on therapy: The earlier the better

Patients with axial spondyloarthritis who respond early on therapy, show a better persistence long term. Physician's treatment expectations do often not mirror those of the patients.

Convenient drug application for the patients important

Patients with axial spondyloarthritis who respond early on therapy, show a better persistence long term. Physician's treatment expectations do often not mirror those of the patients.

“We might have completely different perceptions of what is important for patients”, explains Xenofon Baraliakos, Rheumazentrum Ruhrgebiet, Herne (Germany). For physicians, the main target is ultimately sustained remission, patients are more focused on improvement of function and effects of medication.

Regarding treatment of axial spondyloarthritis (axSpA) with anti-TNF, the first three months on therapy are most important to predict persistence: The lower the “Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)” after 3 months of therapy, the higher are the chances that patients stay on the drug and the better they will do long term. “In this way, we can not only achieve persistence, but even predict persistence”, explains Baraliakos.

Particularly in patients with ankylosing spondylitis (axSpA) it is possible to see a response very early, after only 1-2 weeks of therapy. “The earlier we see a response, the better the patient get long term”, said Baraliakos. This was shown in a trial were patients with axSpA were treated with infliximab and followed for eight years: in this trial, lower BASDAI levels after 12 weeks were predictive of a higher probability of partial remission, low disease activity or remaining on treatment after 8 years.

“We would like to keep patients longer on treatment, because we might gain a structural benefit and can slow down radiographic progression. The longer the treatment lasts, the less radiographic changes we see: this has been shown in a trial, where infliximab was compared to NSAIDs”, explained Baraliakos. Similarly, in Rheumatoid Arthritis (RA) patients that achieve a good response after 3 months, better long term effects could be demonstrated.

Good safety profile facilitates persistence

Not only efficacy, but also safety is important for patients: they care particularly about long term safety. On therapy with golimumab there are side effects, but the percentage of patients who discontinued due to adverse events was very low (< 10%). Obviously, these side effects pose no significant problem for patients.

Treatment with effective drugs has a distinct effect on society: These show trial data on presenteism and absenteeism: both factors decrease after continuous treatment.

The high persistence rates shown in clinical trials could also be demonstrated in an Italian trial presented during this year’s EULAR, where golimumab was assessed in a real world setting in patients with RA, (Psoriatic arthritis) PsA and Ankylosing Spondylitis (AS).

Finally, an important factor to ensure persistence is a convenient drug application for the patients. “Not to forget, credibility of the physician plays a major role in ensuring persistence”, concluded Baraliakos.

Baraliakos X. What is the relevance of persistence on therapy in daily practice for physicians and patients? Symposium “Persistence on therapy: a key factor in the successful management of rheumatic disease”, presented on the 9th of June, 2016 Annual EULAR Meeting.

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