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Cause analysis of conversion to biologics in spondyloarthritis patients with poor response to conventional treatment

Jun Zhou1, Wenhan Huang1, Zhihuan Zhang1

  • 1Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Clinical Rheumatology
|September 23, 2023
PubMed
Abstract

Insights

Early combination therapy with NSAIDs, sulfasalazine, and thalidomide can reduce the need for biologics in spondyloarthritis (SpA) patients. This approach offers an alternative for those unable to use biologics due to disease control issues.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Clinical Medicine

Background:

  • Spondyloarthritis (SpA) management often involves non-steroidal anti-inflammatory drugs (NSAIDs) and conventional synthetic disease-modifying antirheumatic drugs (cDMARDs).
  • Treatment failure with conventional therapies necessitates understanding reasons for switching to biologics.

Purpose of the Study:

  • Investigate factors leading to treatment failure with NSAIDs and cDMARDs in SpA patients.
  • Evaluate the impact of initial cDMARD strategies on the likelihood of transitioning to biologic therapies.

Main Methods:

  • Patients were categorized into conventional drug maintenance and biologic conversion groups.
  • Initial treatments were classified into NSAID monotherapy, double combination (NSAID + sulfasalazine or thalidomide), and triple combination (NSAID + sulfasalazine + thalidomide) therapy groups.

Main Results:

  • Uveitis correlated positively with biologic conversion (OR 5.356), while older age correlated negatively (OR 0.940).
  • Conversion rates to biologics were 80% for NSAID monotherapy, 51.1% for double combination, and 23.2% for triple combination therapy (P < 0.05).
  • The conventional drug maintenance group was older than the biologics conversion group (40.8 ± 14.3 vs. 33.8 ± 12.3 years, P < 0.05).

Conclusions:

  • Age and uveitis influence the decision to switch to biologics in SpA.
  • Early combination therapy (NSAIDs with sulfasalazine and thalidomide) reduces the probability of later biologic conversion.
  • Combination drug therapy is superior to monotherapy for SpA control and decreasing biologic conversion, offering an alternative for patients with limited biologic options.
Keywords:
BiologicsConventional synthetic DMARDsNSAIDsSpondyloarthritis

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