{
  "abstract": "Objective To characterise patients with ‘very early’ axial spondyloarthritis (axSpA), defined as a duration ≤1 year of back pain and to determine the effectiveness of a first tumour necrosis factor inhibitor (TNFi) in very early versus established axSpA in a large observational registry.Methods We included a total of 3324 patients with axSpA from the Swiss Clinical Quality Management in Rheumatic Diseases registry with available data on duration of back pain (≤1 year=very early axSpA, n=441; >1 year and ≤2 years=early axSpA, n=218; >2 years=established axSpA, n=2575). A first TNFi was started in 31%, 38% and 36% of patients with very early, early and established axSpA. Adjusted logistic regression models were used to compare the probability of achieving low disease activity status according to the Axial Spondyloarthritis Disease Activity Score (ASDAS <2.1) at 1 year. Drug survival was analysed with multiple-adjusted Cox proportional hazards models. Missing data were handled using multiple imputation by chained equations.Results Objective signs of inflammation were more prevalent in very early disease. No difference was found regarding the achievement of ASDAS <2.1 after adjustment for age, sex, human leucocyte antigen-B27 status, education, body mass index, smoking, ASDAS and sacroiliac inflammation on MRI (OR 1.08, 95% CI 0.70 to 1.68 in very early vs established axSpA). Similarly, no significant difference in TNFi retention was found in very early versus established axSpA (HR for drug discontinuation 1.05, 95% CI 0.84 to 1.31).Conclusion We found no evidence for a better effectiveness of TNFi in patients with very early versus established axSpA.",
  "authors": [
    {
      "affiliations": [
        "Department of Rheumatology, Zürich University Hospital, University of Zürich, Zürich, Switzerland"
      ],
      "name": "Mauro Bachmann"
    },
    {
      "affiliations": [
        "Swiss Clinical Quality Management in Rheumatic Diseases Foundation, Zürich, Switzerland"
      ],
      "name": "Andrea Götschi"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Zürich University Hospital, University of Zürich, Zürich, Switzerland"
      ],
      "name": "Annik Steimer"
    },
    {
      "affiliations": [
        "Swiss Clinical Quality Management in Rheumatic Diseases Foundation, Zürich, Switzerland"
      ],
      "name": "Jonas Brändli"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Zürich University Hospital, University of Zürich, Zürich, Switzerland"
      ],
      "name": "Kristina Bürki"
    },
    {
      "affiliations": [
        "Rheumatologie im Zürcher Oberland, Uster, Switzerland"
      ],
      "name": "Michael Andor"
    },
    {
      "affiliations": [
        "Swiss Clinical Quality Management in Rheumatic Diseases Foundation, Zürich, Switzerland"
      ],
      "name": "Claudia Lourenço Rodrigues"
    },
    {
      "affiliations": [
        "Ankylosing Spondylitis Association, Zürich, Switzerland"
      ],
      "name": "Simon Grosswiler"
    },
    {
      "affiliations": [
        "Johns Hopkins University School of Advanced International Studies, Washington, DC, USA",
        "Eidgenössische Technische Hochschule Zurich, Zürich, Switzerland"
      ],
      "name": "Martin Wendiggensen"
    },
    {
      "affiliations": [
        "Department of Rheumatology, University Hospital Basel, University of Basel, Basel, Switzerland"
      ],
      "name": "Diego Kyburz"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland"
      ],
      "name": "Michael J Nissen"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland"
      ],
      "name": "Burkhard Möller"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland",
        "Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland"
      ],
      "name": "Sabine Adler"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland"
      ],
      "name": "Diana Dan"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland"
      ],
      "name": "Frauke Förger"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Zürich University Hospital, University of Zürich, Zürich, Switzerland"
      ],
      "name": "Oliver Distler"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands",
        "Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands"
      ],
      "name": "Sofia Ramiro"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Zürich University Hospital, University of Zürich, Zürich, Switzerland"
      ],
      "name": "Raphael Micheroli"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Zürich University Hospital, University of Zürich, Zürich, Switzerland"
      ],
      "name": "Adrian Ciurea"
    }
  ],
  "title": "Effectiveness of TNF inhibitors in patients with very early axial spondyloarthritis, defined as duration of ≤1 year of back pain: longitudinal observational data from the SCQM registry",
  "uid": "06c33c84-aa41-5821-bd0c-9d5f271343b7"
}