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Master Thesis

Influence des co-médications sur la réponse aux anti-TNF dans la spondyloarthrite axiale

Abstract : Objective: considering the potential role of the gut microbiota in the pathophysiology of spondyloarthritis (SpA) as in the therapeutic response to biologics, we studied the influence of co-medications known to interfere with the microbiota with the therapeutic response to TNF-inhibitor (TNF-i) in SpA patients. Methods: this was a retrospective cohort including patients having axial SpA (ax-SpA). Patients were classified as responder (R) or non-responder (NR) according to the BASDAI (< 40/100) value at month 6 or to the clinician judgment. We collected co-medication administered 1 month before and during the first 3 months of the TNF-i treatment. A replication cohort was built for validation of the results. Multivariate logistic regression models adjusted for potential confounders were applied to evaluate the relationship between co-medications and TNF-i response. Results: we included 188 patients of whom 135 (72%) were considered as R. In univariate analysis, nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), antibiotics and psychotropic drugs intakes were significantly associated with a higher proportion of NR patients, unlike for corticosteroids, methotrexate (MTX), angiotensin-converting enzyme inhibitors and statins use. NSAIDs, PPIs and antibiotics intakes were considered as independent factors associated with TNF-i failure in multivariate analysis. 185 patients were included in the replication cohort, including 127 (69%) R patients. In multivariate analysis, although 88% of patients taking PPIs were also given NSAIDs, PPIs remained associated with a poorer response to a first TNF-i (p<0.001). Conclusion: co-medication with PPIs was significantly associated with a decreased chance to respond to TNF-i. The hypothesis that this effect is due to their interference with the gut microbiota is only speculative but, regardless of the reason for this interaction, clinicians should be aware of the potential negative effect of PPIs on TNF-i.
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Submitted on : Tuesday, August 31, 2021 - 11:41:49 AM
Last modification on : Tuesday, October 12, 2021 - 3:22:28 AM


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  • HAL Id : dumas-03329780, version 1



Maëva Masson. Influence des co-médications sur la réponse aux anti-TNF dans la spondyloarthrite axiale. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03329780⟩



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