OP0052 FACTORS ASSOCIATED WITH REMISSION AT 5 YEARS OF FOLLOW-UP IN EARLY ONSET AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE DESIR COHORT
Authors: Pina Vegas L. , Sbidian E. , Wendling D. , Goupille P. , Ferkal S. , Le Corvoisier P. , Ghaleh B. , Luciani A. , Claudepierre P. 
Published: May 2021

Background:

The disease course of axial SpA (axSpA) is highly variable and can be characterized by ongoing axial inflammation and radiographic progression associated with restricted mobility of the spine, reduced function and disability leading to impairment in quality of life. Control of disease activity is a primary aim in axSpA management. To assess disease activity the Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) is often considered as a reference tool. The data on remission are spare in axSpA and the identification of long-term remission factors, enabling the patient’s management to be adapted, seems necessary but remains unclear.

Objectives:

To evaluate the proportion of patients in remission according to ASDAS-CRP at 5 years of follow-up, to describe their characteristics in comparison with patients with active disease at that time, and to identify baseline factors associated with remission at 5 years of follow-up.

Methods:

We included all patients from the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort with available data on ASDAS-CRP at 5-year follow-up and TNFα inhibitors exposure. Patients in remission, defined as an ASDAS-CRP<1.3, and with active disease were compared according to their main demographic, clinical, biological and radiological characteristics. A logistic model stratified on TNFα inhibitors exposure was used in the main analysis. Sensitivity analyses among patients with axSpA diagnosis confirmed by rheumatologist at 5-years were performed.

Results:

A total of 614 patients were followed in the DESIR cohort at M60. After excluding those with missing data on ASDAS score (n= 163) and TNFα inhibitors exposure (n= 2), analyzed patients were 449 (73%). Excluded patients had similar baseline characteristics to those included in the analysis. Among patients unexposed to TNFα inhibitors (n=247), 77 (31%) were in remission (37,8±8,3 years; 55% men, 58% NSAID users), 170 (69%) weren’t (39,8±8,6 years; 42% men, 81% NSAID users). Among exposed patients (n=202), 34 (17%) were in remission (36,1±8,1 years; 71% men, 29% NSAID users), 168 (83%) weren’t (39,5±9,0 years; 41% men, 63% NSAID users) (Figure 1). Overall, patients in remission were more frequently men, HLA-B27+, with high education and lower BMI at 5-year of follow-up. The baseline factors associated with remission at 5 years of follow-up from the multivariate analysis are presented in Table 1.

Table 1.

Baseline factors associated with remission at 5-year follow-up (multivariate analysis)

TNFα: Tumor Necrosis Factor alpha; ORa: adjusted Odd Ratio; 95%IC: 95% confidence interval; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BMI: Body Mass Index.

Conclusion:

The overall remission rate at 5 years was 25%, 31% among patients unexposed to TNFα inhibitors and 17% among those exposed. This study reveals the difficulty in achieving 5-year remission in recent axSpA, especially in the most active forms at baseline; socio-educational factors and overweight also appear to be related.

Acknowledgements:

L Pina Vegas received a Master 2 grant from the French Society of Rheumatology (Bourse Master 2ème Année 2019)

Disclosure of Interests:

Laura Pina Vegas: None declared, Emilie Sbidian: None declared, Daniel Wendling: None declared, Philippe Goupille: None declared, Salah Ferkal: None declared, Philippe Le Corvoisier: None declared, Bijan Ghaleh: None declared, Alain Luciani: None declared, Pascal Claudepierre Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, Pfizer, Roche-Chugai, Bristol-Myers Squibb, MSD, UCB, Novartis, Janssen, Lilly, Celgene (consulting fees, less than 10,000 $ each)., Employee of: Roche Chugai, Sanofi Aventis, Celgene, Pfizer, MSD, Novartis and BMS (investigator).