Effectiveness, safety and drug survival of tumor necrosis factor-α inhibitors in the treatment of spondyloarthritis: A real-life study in Tunisia

Aim of the work: The aim of the present study was to evaluate effectiveness of anti-tumor necrosis factor-α (anti-TNFα) in the treatment of spondyloarthritis (SpA) and to assess their safety and drug survival. Patients and methods: Forty-two SpA patients (33 men, 9 women) were retrospectively studied. The disease was progressive in all patients. Response was assessed after 6 months using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Functional Index (BASFI) scores and other clinical parameters. A major clinical response was defined as 50% improvement of the initial BASDAI. Patients were grouped into those with ankylosing spondylitis (AS) (24 patients) or psoriatic arthritis (PsA) and enteropathic arthritis (EA) (18 patients) and the response to anti-TNF was compared. Results: The mean age of the patients was 41.3 ± 9.7 years and disease duration 14.6 ± 8.2 years. After 6 months, 74% of patients were BASDAI 50 responders. The mean BASDAI and BASFI scores varied from 56 ± 20 and 61.8 ± 26 to 19 ± 19 and 24 ± 25 respectively (p < .001). The two SpA groups had the same effectiveness profile. The comparison between them showed a greater reduction of morning stiffness duration and erythrocyte sedimentation rate in patients with PsA or EA (p = .04). At least, one adverse event developed by 48% of patients and it was severe in 12%. Bronchopulmonary infections were the most frequent (8 patients). Drug survival rate was estimated at 86% after 1 year of treatment. Conclusion: Anti-TNFα therapy has a good response rate in SpA patients and an acceptable safety profile which explains the high drug survival rates. Keywords: Spondyloarthritis, Anti-TNF, Effectiveness, Safety, Drug surviva