Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI
ObjectivesTo compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).MethodsPatients fro...
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doaj-eb54909a58d74d8c9a6f4f5cbba9f9422020-12-14T14:47:53ZengBMJ Publishing GroupRMD Open2056-59332020-05-016110.1136/rmdopen-2019-001145Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAISofia Ramiro0Alexandre Sepriano1Jose Marona2Santiago Rodrigues-Manica3Fernando Pimentel-Santos4Ana Filipa Mourão5Nélia Gouveia6Jaime Cunha Branco7Filipe Vinagre8João Tavares-Costa9João Rovisco10Miguel Bernardes11Nathalie Madeira12Rita Cruz-Machado13Raquel Roque14Joana Leite Silva15Mary Lucy Marques16Raquel Miriam Ferreira17Leiden University Medical Center, Leiden, Netherlands8 NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, PortugalRheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, PortugalRheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, PortugalRheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, PortugalCEDOC – NOVA Medical School | Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, PortugalRheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, PortugalRheumatology, Hospital Garcia de Orta EPE, Almada, PortugalRheumatology, Unidade Local de Saude do Alto Minho EPE, Viana do Castelo, PortugalRheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, PortugalRheumatology, Centro Hospitalar de Sao Joao EPE, Porto, PortugalRheumatology, Instituto Português de Reumatologia, Lisboa, PortugalRheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, PortugalRheumatology, Hospital Garcia de Orta EPE, Almada, PortugalRheumatology, Unidade Local de Saude do Alto Minho EPE, Viana do Castelo, PortugalRheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, PortugalRheumatology, Centro Hospitalar de Sao Joao EPE, Porto, PortugalObjectivesTo compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).MethodsPatients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models.ResultsOf the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI<4 was much larger than the opposite (ie, ASDAS <2.1, if BASDAI≥4): 62% vs 0.8%. Compared to patients fulfilling both definitions, those with ASDAS ≥2.1 only were more likely to be male (77% vs 51%), human leucocyte antigen B27 positive (79% vs 65%) and have a higher C reactive protein (2.9 (SD 3.5) vs 2.1 (2.9)). Among bDMARD-treated patients (n=359), responses across subgroups were globally overlapping, except for the most ‘stringent’ outcomes. Patients captured only by ASDAS responded better compared to patients fulfilling both definitions (eg, ASDAS inactive disease at 3 months: 61% vs 25% and at 6 months: 42% vs 25%).ConclusionThe ASDAS definition of high disease activity is more inclusive than the BASDAI definition in selecting patients with axSpA for bDMARD treatment. The additionally ‘captured’ patients respond better and have higher likelihood of predictors thereof. These results support using ASDAS≥2.1 as a criterion for treatment decisions.https://rmdopen.bmj.com/content/6/1/e001145.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sofia Ramiro Alexandre Sepriano Jose Marona Santiago Rodrigues-Manica Fernando Pimentel-Santos Ana Filipa Mourão Nélia Gouveia Jaime Cunha Branco Filipe Vinagre João Tavares-Costa João Rovisco Miguel Bernardes Nathalie Madeira Rita Cruz-Machado Raquel Roque Joana Leite Silva Mary Lucy Marques Raquel Miriam Ferreira |
spellingShingle |
Sofia Ramiro Alexandre Sepriano Jose Marona Santiago Rodrigues-Manica Fernando Pimentel-Santos Ana Filipa Mourão Nélia Gouveia Jaime Cunha Branco Filipe Vinagre João Tavares-Costa João Rovisco Miguel Bernardes Nathalie Madeira Rita Cruz-Machado Raquel Roque Joana Leite Silva Mary Lucy Marques Raquel Miriam Ferreira Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI RMD Open |
author_facet |
Sofia Ramiro Alexandre Sepriano Jose Marona Santiago Rodrigues-Manica Fernando Pimentel-Santos Ana Filipa Mourão Nélia Gouveia Jaime Cunha Branco Filipe Vinagre João Tavares-Costa João Rovisco Miguel Bernardes Nathalie Madeira Rita Cruz-Machado Raquel Roque Joana Leite Silva Mary Lucy Marques Raquel Miriam Ferreira |
author_sort |
Sofia Ramiro |
title |
Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI |
title_short |
Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI |
title_full |
Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI |
title_fullStr |
Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI |
title_full_unstemmed |
Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI |
title_sort |
eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond basdai |
publisher |
BMJ Publishing Group |
series |
RMD Open |
issn |
2056-5933 |
publishDate |
2020-05-01 |
description |
ObjectivesTo compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).MethodsPatients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models.ResultsOf the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI<4 was much larger than the opposite (ie, ASDAS <2.1, if BASDAI≥4): 62% vs 0.8%. Compared to patients fulfilling both definitions, those with ASDAS ≥2.1 only were more likely to be male (77% vs 51%), human leucocyte antigen B27 positive (79% vs 65%) and have a higher C reactive protein (2.9 (SD 3.5) vs 2.1 (2.9)). Among bDMARD-treated patients (n=359), responses across subgroups were globally overlapping, except for the most ‘stringent’ outcomes. Patients captured only by ASDAS responded better compared to patients fulfilling both definitions (eg, ASDAS inactive disease at 3 months: 61% vs 25% and at 6 months: 42% vs 25%).ConclusionThe ASDAS definition of high disease activity is more inclusive than the BASDAI definition in selecting patients with axSpA for bDMARD treatment. The additionally ‘captured’ patients respond better and have higher likelihood of predictors thereof. These results support using ASDAS≥2.1 as a criterion for treatment decisions. |
url |
https://rmdopen.bmj.com/content/6/1/e001145.full |
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