La sensibilité initiale aux anti-inflammatoires non stéroïdiens est-elle prédictive d'une bonne réponse au premier anti-TNF utilisé pour les spondyloarthrites axiales récentes

Abstract : Background: Good response to NSAIDs is a SpA feature included in classification criteria for axial spondyloarthritis (axSpA). Among patients eligible for a TNF inhibitor (TNFi), some patients may have never been good NSAIDs responders (NSAIDs non-responders) while others primary responded before secondary failure (NSAIDs responders). Our aim was to determine if the primary good NSAIDs response is an independent predictive factor of a subsequent good response to the first TNFi in axSpA. Methods: Patient were selected from the DESIR cohort. Were included patients initiating a TNFi over the first 5 years of follow-up. NSAIDs response was defined according to Amor’s criteria. TNFi response was determined by the BASDAI50 response after at least 8 weeks of treatment. We compared good NSAIDs responders to the non-responders characteristics and their response to the first TNFi.
We performed a multivariate logistic regression modeling the impact of NSAIDs response to the TNFi response and applied a propensity score with Inverse Probability Weighting (IPW) method as a sensitivity analysis. Results: A total of 236 patients treated by TNFi over follow-up were included. At baseline, 202/236 (85.6%) were good NSAIDs responders. TNFi responders rate was 32.2% and 23.5% among good NSAIDs responders and non-responders, respectively ([OR=1.5 [CI95%:0.7-3.6], p=0.313).
 In multivariate analysis, gender, age, HLA-B27, ASDAS and MRI sacroiliitis were associated to the TNFi response. NSAIDs good response was not associated to the TNFi response (aOR=1.93 [CI95%:0.6-6.3], p=0.275). Conclusion: NSAIDs good response does not appear to be an independent predictive factor of subsequent TNFi response in early axSpA patients.
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Loukianos Couvaras. La sensibilité initiale aux anti-inflammatoires non stéroïdiens est-elle prédictive d'une bonne réponse au premier anti-TNF utilisé pour les spondyloarthrites axiales récentes. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01961702⟩

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