258 The Journal of Rheumatology 2015; 42:2; doi:10.3899/jrheum.140811 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2015. All rights reserved. Remission in Nonradiographic Axial Spondyloarthritis Treated with Anti-tumor Necrosis Factor-a Drugs: An Italian Multicenter Study Ennio Lubrano, Fabio Massimo Perrotta, Antonio Marchesoni, Salvatore D’Angelo, Roberta Ramonda, Olga Addimanda, Ignazio Olivieri, Leonardo Punzi, and Carlo Salvarani ABSTRACT. Objective. To investigate the possibility of achieving partial remission (PR) in patients with non-radio- graphic axial spondyloarthritis (nr-axSpA) versus ankylosing spondylitis (AS) treated with anti-tumor necrosis factor (TNF)-a antagonists, such as adalimumab (ADA), etanercept (ETN), and infliximab (IFX), in a real clinical practice setting. The Assessment of SpondyloArthritis international Society (ASAS) 20, ASAS40, and Ankylosing Spondylitis Disease Activity Score were also calculated. Methods. A retrospective study was conducted in patients with axSpA treated with ADA, ETN, and IFX from 2000 to 2013. All patients fulfilled the ASAS or the modified New York criteria. PR was reached when the score was < 20 mm (on a visual analog scale of 0–100 mm) in each of these domains: (1) patient global assessment, (2) pain, (3) function, and (4) inflammation. Results. A total of 321 patients with axSpA were treated. Among them, 62 were nr-axSpA while the remaining 259 were AS. Log-rank test to compare survival curves showed that the probability of obtaining PR in nr-axSpA and AS during treatment with anti-TNF-a was not significantly different. At 12 weeks of exposure to the first anti-TNF-a drug, PR was achieved in 7 patients with nr-axSpA (11.3%) and in 68 patients with AS (26.2%). Conclusion. Our results, obtained from clinical practice, showed that PR is an achievable target of anti-TNF-a treatment in nr-axSpA. The PR rate, as a reliable indicator of sustained effectiveness, is similar in nr-axSpA and in AS. (First Release Dec 15 2014; J Rheumatol 2015;42:258–63; doi:10.3899/jrheum.140811) Key Indexing Terms: NONRADIOGRAPHIC AXIAL SPONDYLOARTHRITIS ANKYLOSING SPONDYLITIS REMISSION ANTI-TNF-a DRUGS Academic Rheumatology Unit, Department of Medicine and Health Science, University of Molise, Campobasso; Dipartimento di Medicina Interna e Specialità Mediche, L’Unità Operativa Complessa (UOC) di Reumatologia “Sapienza” Università di Roma, Rome; Rheumatology Unit, Orthopedic Institute G. Pini, Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza; Rheumatology Unit, Department of Medicine, Dipartimento di Medicina (DIMED), University of Padua, Padua; S.C. Reumatologia, Dipartimento Medicina Interna e Specialità Mediche Arcispedale Santa Maria Nuova, Azienda Ospedaliera-IRCCS di Reggio Emilia, Reggio Emilia, Italy. The authors have received honoraria from Abbott; Bristol Meyer Squibb; Merck, Sharp & Dome; Pfizer; UCB pharma; and Roche to attend scientific meetings. E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Science, University of Molise; F.M. Perrotta, MD, Dipartimento di Medicina Interna e Specialità Mediche, UOC di Reumatologia “Sapienza” Università di Roma; A. Marchesoni, MD, Rheumatology Unit, Orthopedic Institute G. Pini; S. D’Angelo, MD; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; R. Ramonda, MD; L. Punzi, MD, Rheumatology Unit, DIMED, University of Padua; O. Addimanda, MD; C. Salvarani, MD, S.C. Reumatologia, Dipartimento Medicina Interna e Specialità Mediche Arcispedale Santa Maria Nuova, Azienda Ospedaliera-IRCCS di Reggio Emilia. Address correspondence to Dott. E. Lubrano, Department of Medicine and Health Science, Rheumatology Unit, University of Molise, Via Giovanni Paolo II, 86100, Campobasso, Italy. E-mail: enniolubrano@hotmail.com Accepted for publication October 16, 2014. The Assessment of SpondyloArthritis international Society (ASAS) has validated classification criteria for patients with axial spondyloarthritis (axSpA) 1 , including nonradiographic axSpA (nr-axSpA) and ankylosing spondylitis (AS). Patients with nr-axSpA and those with AS have comparable, but not identical, clinical manifestations and burden of disease, requiring treatment irrespective of the presence of radiographic damage 2,3 . Randomized clinical trials with tumor necrosis factor (TNF)-a antagonists such as infliximab (IFX), etanercept (ETN), adalimumab (ADA), and certolizumab pegol (CZP) for the treatment of nr-axSpA have been performed 4,5,6,7,8 . In these studies, the ASAS criteria were applied, but partial remission (PR) has been considered as primary endpoint in only 1 randomized controlled trial study including about 60% of patients who met the modified New York criteria for AS 5 . Moreover, to our knowledge, direct comparison among TNF-a blockers has not been reported in nr-axSpA. The primary objective of our retrospective study was to investigate the possibility of achieving PR in nr-axSpA as opposed to patients with AS treated with TNF-a antago- nists, such as ADA, ETN, and IFX, in a real clinical practice setting. Secondary endpoints were the proportion of patients www.jrheum.org Downloaded on January 13, 2022 from