Evaluation of extreme patient-reported outcome in early spondyloarthritis and its impact on the effect of TNF-α blockers treatment

Clin Exp Rheumatol. 2018 Nov-Dec;36(6):1043-1048. Epub 2018 Aug 29.


Objectives: To describe the prevalence of extreme patient-reported outcomes (PRO) in an early axial spondyloarthritis setting, to compare the phenotype of patients with/without extreme PRO and to evaluate the impact of extreme PRO on the effectiveness of TNF-α blockers (TNFb).

Methods: This analysis was performed in the DESIR cohort. Extreme PRO were measured at baseline and were defined as a score ≥8 on at least three of first five BASDAI items. Phenotype of patient's with/without extreme PRO was compared. Impact of extreme PRO on TNFb effectiveness was evaluated by comparing the retention rate of the first TNFb in both groups by survival curves analysis (log-rank and Cox analysis).

Results: Extreme PRO were present in 95 out of the 708 patients (13.4%). Patients with extreme PRO were older (mean (SD) age of 35.4(8.6) years vs. 33.5(8.7) years), more frequently females (65.3% vs. 51.9%), had higher BASDAI (7.1 vs. 4.1), reported more frequently history of depression (25.3% vs. 10.2%) and use of anti-depressive drugs (19.0% vs. 7.2%). TNFb treatment was more frequently initiated in the extreme PRO group (48.4% vs. 25.5%), while the proportion of patients still on TNFb at 2 years was significantly lower in the extreme PRO group 18.6% (n=8) vs. 39.5% (n=60). Presence of extreme PRO was independently associated with first TNFb discontinuation (HR 1.8, [95% CI 1.2;2.9], p=0.01)).

Conclusions: Although presence of extreme PRO in this early axSpA setting was not very frequent, patients with extreme PRO were more likely to receive a TNFb and less likely to maintain the treatment at 2 years. Further studies evaluating the specific impact of extreme PRO on TNFb treatment in axSpA are warranted.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use*
  • Biological Products / adverse effects
  • Biological Products / therapeutic use*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Phenotype
  • Risk Factors
  • Spondylarthritis / diagnosis
  • Spondylarthritis / drug therapy*
  • Spondylarthritis / immunology
  • Time Factors
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / immunology


  • Antirheumatic Agents
  • Biological Products
  • Tumor Necrosis Factor-alpha