PMID- 32641447
OWN - NLM
STAT- MEDLINE
DCOM- 20210421
LR  - 20210421
IS  - 2056-5933 (Electronic)
IS  - 2056-5933 (Linking)
VI  - 6
IP  - 2
DP  - 2020 Jul
TI  - Predictors of extra-articular manifestations in axial spondyloarthritis and their 
      influence on TNF-inhibitor prescribing patterns: results from the British Society 
      for Rheumatology Biologics Register in Ankylosing Spondylitis.
LID - 10.1136/rmdopen-2020-001206 [doi]
LID - e001206
AB  - OBJECTIVES: Extra-articular manifestations (EAMs) are important systemic features 
      of axial spondyloarthritis (axSpA), which may influence the choice of tumour 
      necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and 
      predictors of EAMs and the influence of these on first TNFi choice in a 
      'real-world' cohort of patients with axSpA. METHODS: Clinical and 
      patient-reported outcomes of 2420 patients with axSpA from 83 centres were 
      collected by the British Society for Rheumatology Biologics Register in 
      Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), 
      inflammatory bowel diseases (IBD), psoriasis) were compared with those without 
      EAMs. Also, the association between pretreatment EAMs and choice of first TNFi 
      (adalimumab, etanercept, certolizumab) was analysed. RESULTS: AAU was directly 
      associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 
      1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 
      95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse 
      relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 
      0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 
      6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for 
      adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 
      0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less 
      preference for etanercept over other TNFi. CONCLUSION: The higher occurrence of 
      AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with 
      axSpA are consistent with current pathophysiology. Patients with previous AAU and 
      IBD are more likely to be prescribed adalimumab and less likely to receive 
      etanercept, consistent with the superior efficacy of monoclonal TNFi for these 
      indications. Future work will determine whether EAMs influence TNFi survival, or 
      effectiveness, and whether this varies between agents.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Derakhshan, Mohammad H
AU  - Derakhshan MH
AUID- ORCID: 0000-0002-2549-7100
AD  - Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, 
      UK Mohammad.derakhshan@glasgow.ac.uk, karl.gaffney@nnuh.nhs.uk.
FAU - Dean, Linda
AU  - Dean L
AUID- ORCID: 0000-0001-7667-5352
AD  - Epidemiology Group, Univesity of Aberdeen, Aberdeen, UK.
FAU - Jones, Gareth T
AU  - Jones GT
AUID- ORCID: 0000-0003-0016-7591
AD  - Epidemiology Group, Univesity of Aberdeen, Aberdeen, UK.
FAU - Siebert, Stefan
AU  - Siebert S
AUID- ORCID: 0000-0002-1802-7311
AD  - Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, 
      UK.
FAU - Gaffney, Karl
AU  - Gaffney K
AUID- ORCID: 0000-0002-7863-9176
AD  - Rheumatology Department, Norfolk and Norwich University Hospital, Norwich, UK 
      Mohammad.derakhshan@glasgow.ac.uk, karl.gaffney@nnuh.nhs.uk.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - RMD Open
JT  - RMD open
JID - 101662038
RN  - 0 (HLA-B27 Antigen)
RN  - 0 (Tumor Necrosis Factor Inhibitors)
RN  - FYS6T7F842 (Adalimumab)
RN  - OP401G7OJC (Etanercept)
RN  - UMD07X179E (Certolizumab Pegol)
SB  - IM
MH  - Adalimumab/therapeutic use
MH  - Adult
MH  - Certolizumab Pegol/therapeutic use
MH  - Etanercept/therapeutic use
MH  - Female
MH  - HLA-B27 Antigen/genetics
MH  - Humans
MH  - Inflammatory Bowel Diseases/*complications
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Psoriasis/*complications
MH  - Registries
MH  - Societies, Medical
MH  - Spondylitis, Ankylosing/*drug therapy/genetics
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor Inhibitors/*therapeutic use
MH  - United Kingdom
MH  - Uveitis, Anterior/*complications
PMC - PMC7425116
OTO - NOTNLM
OT  - Anti-TNF
OT  - Epidemiology
OT  - Spondyloarthritis
COIS- Competing interests: GTJ reports grants from AbbVie, Pfizer and UCB during the 
      conduct of the study; grants from Amgen and GlaxoSmithKline, outside the 
      submitted work. SS has received research grants, speaker or consultancy fees from 
      AbbVie, Amgen (previously Celgene), BMS, Boehringer-Ingelheim, GlaxoSmithKline, 
      Janssen, Novartis, Pfizer and UCB. KG has received research grants, speaker or 
      consultancy fees from AbbVie, Celgene, Biogen, MSD, Novartis, Pfizer and UCB 
      Pharma. Other authors have no relevant interests to declare.
EDAT- 2020/07/10 06:00
MHDA- 2021/04/22 06:00
PMCR- 2020/07/08
CRDT- 2020/07/10 06:00
PHST- 2020/02/19 00:00 [received]
PHST- 2020/05/11 00:00 [revised]
PHST- 2020/06/07 00:00 [accepted]
PHST- 2020/07/10 06:00 [entrez]
PHST- 2020/07/10 06:00 [pubmed]
PHST- 2021/04/22 06:00 [medline]
PHST- 2020/07/08 00:00 [pmc-release]
AID - rmdopen-2020-001206 [pii]
AID - 10.1136/rmdopen-2020-001206 [doi]
PST - ppublish
SO  - RMD Open. 2020 Jul;6(2):e001206. doi: 10.1136/rmdopen-2020-001206.