Baseline Variables Predict Probability of Initial Response to TNFi Inhibitors in Patients With AS

More personalized treatment decision-making may be possible based on results of a study demonstrating the success of predicting probability of tumor necrosis factor inhibitor (TNFi) response in patients with ankylosing spondylitis (AS).

Researchers designed a retrospective cohort study of TNFi treatment groups from 10 phase 3 or 4 randomized clinical trials of patients with active (AS) which were conducted between 2002 and 2016. Included trials assessed the efficacy of a TNFi at 12 and/or 24 weeks and compared placebo with an antirheumatic drug. For the purpose of this analysis conducted between July 1, 2019 and November 30, 2020, researchers divided the cohort into either a training or testing set. Eligible participants had previously failed nonsteroidal anti-inflammatory drugs.

From the 10 included trials, a total of 1899 patients were assessed. “The training set included 1207 individuals (mean [SD] age, 39 [12] years; 908 [75.2%] men), of whom 407 (33.7%) had major response and 414 (34.3%) had no response, said researchers.

Accuracy was 0.74 and 0.75 for major and no response, respectively, in the reduced logistic regression models.

“The probability of major response increased with higher C-reactive protein (CRP) level, patient global assessment (PGA), and Bath AS Disease Activity Index (BASDAI) question 2 score and decreased with higher body mass index (BMI) and Bath AS Functional Index (BASFI) score,” found researchers.

Increasing age and BASFI scores were associated with a probability of no response. Probability of no responses decreased with high CRP level, BASDAI question 2 score, and PGA.

According to data from the testing test, the developed models demonstrated moderate to high prediction accuracy.

Researchers concluded the probability of initial response to TNFi was predicted from baseline variables, which may facilitate personalized treatment decision-making.

Reference:
Wang R, Dasgupta A, Ward MM. Predicting Probability of Response to Tumor Necrosis Factor Inhibitors for Individual Patients With Ankylosing Spondylitis. JAMA Netw Open. 2022;5(3):e222312. doi:10.1001/jamanetworkopen.2022.2312