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axSpA disease outcome measures

Explore different disease outcome measures…

…and their importance in defining axSpA disease activity in clinical practice.

axSpA=axial spondyloarthritis.

Many patients with axSpA are not reaching optimal disease outcome goals in clinical practice1-3

~35%-80% of patients do not achieve ASDAS low disease activity1,3*

*ASDAS low disease defined as ASDAS <2.1
ASDAS=Ankylosing Spondylitis Disease Activity Score.

~75%-90% of patients do not achieve ASDAS inactive disease1,2*

*ASDAS inactive disease defined as ASDAS <1.3

Barriers to achieving optimal disease outcomes in axSpA

The decision-making pathway for clinicians is complex. There are multiple reasons why patients do not achieve optimal disease activity goals.4

Challenges in axSpA disease management include:
  • Heterogeneous disease manifestations5-7
  • Delayed diagnosis, no standard diagnostic tests, and prolonged symptom duration8-10
  • No consensus on preferred disease activity measure11
  • Patient and clinician discordance on most important disease outcomes12

A recent study showed that only ~20% of patients with axSpA were routinely assessed using composite outcome measures in clinical practice11

There is an opportunity to address this unmet need in the management of patients with axSpA.11

Routine implementation of stringent measures of axSpA disease activity is a critical factor in patient management to optimize disease outcomes.13-17

How does the complexity of pathobiology affect the decision-making pathway?

Understanding the pathologic processes leading to axSpA is important to assessing and achieving improved disease outcomes.

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Setting higher goals

Explore how the implementation of more stringent measures of axSpA disease activity is key to optimizing disease outcomes.

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axSpA manifestations

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  1. Michelsen B, Lindström U, Codreanu C, et al. Drug retention, inactive disease and response rates in 1860 patients with axial spondyloarthritis initiating secukinumab treatment: routine care data from 13 registries in the EuroSpA collaboration. RMD Open. 2020;6(3) doi:10.1136/rmdopen-2020-001280
  2. Ørnbjerg LM, Brahe CH, Askling J, et al. Treatment response and drug retention rates in 24 195 biologic-naïve patients with axial spondyloarthritis initiating TNFi treatment: routine care data from 12 registries in the EuroSpA collaboration. Ann Rheum Dis. 2019;78(11):1536-1544. doi:10.1136/annrheumdis-2019-215427
  3. Michelena X, Zhao SS, Dubash S, et al. Similar biologic drug response regardless of radiographic status in axial spondyloarthritis: data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis registry. Rheumatology. 2021;60(12):5795-5800. doi:10.1093/rheumatology/keab070
  4. Garg N, van den Bosch F, Deodhar A. The concept of spondyloarthritis: where are we now? Best Pract Res Clin Rheumatol. 2014;28(5):663-72. doi:10.1016/j.berh.2014.10.007
  5. Navarro-Compán V, Sepriano A, El-Zorkany B, et al. Axial spondyloarthritis. Ann Rheum Dis. 2021;80(12):1511-1521. doi:10.1136/annrheumdis-2021-221035
  6. Taurog JD, Chhabra A, Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 2016;374(26):2563-74. doi:10.1056/NEJMra1406182
  7. López-Medina C, Dougados M, Ruyssen-Witrand A, et al. Evaluation of concomitant peripheral arthritis in patients with recent onset axial spondyloarthritis: 5-year results from the DESIR cohort. Arthritis Res Ther. 2019;21(1):139. doi:10.1186/s13075-019-1927-6
  8. Zhao SS, Pittam B, Harrison NL, et al. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology. 2021;60(4):1620-1628. doi:10.1093/rheumatology/keaa807
  9. Poddubnyy D, Sieper J. Current unmet needs in spondyloarthritis. Curr Rheumatol Rep. 2019;21(9):43. doi:10.1007/s11926-019-0844-7
  10. Rudwaleit M, Listing J, Brandt J, et al. Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis. 2004;63(6):665-70. doi:10.1136/ard.2003.016386
  11. Dougados M, Lucas J, Desfleurs E, et al. Impact of disease activity outcome measures reporting in the medical records of patients with axial spondyloarthritis on the retention rates of biological treatment: the example of secukinumab use in daily practice in France. RMD Open. 2022;8(1):e002106. doi:10.1136/rmdopen-2021-002106
  12. Spoorenberg A, van Tubergen A, Landewé R, et al. Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology. 2005;44(6):789-95. doi:10.1093/rheumatology/keh595
  13. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-98. doi:10.1002/art.39298
  14. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2022;0:1–16. doi: 10.1136/ard-2022-223296
  15. Machado P, Landewé R, Lie E, et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011;70(1):47. doi:10.1136/ard.2010.138594
  16. Smolen JS, Schöls M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018;77(1):3-17. doi:10.1136/annrheumdis-2017-211734
  17. Kiltz U, Landewé RBM, van der Heijde D, et al. Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis. Annals of the Rheumatic Diseases 2020;79:193-201. doi: 10.1136/annrheumdis-2019-216034