Achieving drug-free remission in axSpA Save

A clinical trial in early axial spondyloarthritis (axSpA) demonstrated sustained inactive disease status in over 60% of patients. In axSpA patients with less than 1 year of disease symptoms, male sex, abstinence from smoking and lower BASDAI score at baseline were associated with higher chances of remission. Despite stable inactive disease state successfully induced by medication, drug-free remission in axSpA remains challenging.

At the 2024 EULAR congress, Łukasik and colleagues shared data from their prospective study evaluating the efficacy of a tight control, treat-to-target approach in newly diagnosed, treatment-naïve axSpA patients – following the ASAS-EULAR disease management recommendations.

Patients were treated with two different non-steroidal anti-inflammatory drugs (NSAID) at optimal doses for a period of at least 4 weeks, but if they did not achieve clinically important improvement, then monotherapy with golimumab was started. Patients were followed until achieving sustained clinical remission – defined as ASDAS-CRP inactive disease state at two consecutive visits with at least 12 weeks interval – or the end of trial. After achieving sustained clinical remission, treatment was stopped and participants were followed in routine clinical practice to evaluate the possibility of maintaining drug-free remission.

Of 55 patients who completed the trial, 61.8% achieved sustained clinical remission, and 21.8% had low disease activity at Week 52. This the first clinical trial in early axSpA in which sustained inactive disease status has been achieved in over 60% of patients. In univariate analysis, only sex and baseline BASDAI score were significantly different between those who did and did not achieve sustained clinical remission. Further multivariate analysis revealed that male sex, abstinence from smoking, and lower BASDAI score were predictors of remission.

Of those who achieved sustained clinical remission and were taken off treatment, 84.8% experienced a disease relapse within 1 year. This happened for all patients who achieved their remission state with NSAID treatment, and the median time to relapse was 61 days – whereas in the golimumab group it was 155 days and 18.2% of patients remained in drug-free remission for over 3 years of follow-up.

Thus, a treat to target approach is able to induce high rates of inactive disease in early axSpA. However, inducing drug-free remission in axSpA remains challenging.

Source

Łukasik Z, et al. Treat-to-target approach allows to induce sustained clinical remission in over 60% of patients with early axial spondyloarthritis. Presented at EULAR 2024; OP0132.