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Kiltz U, Kishimoto M, Walsh JA, Sampaio-Barros P, Mittal M, Saffore CD, Wung P, Ganz F, Biljan A, Poddubnyy D. Effect of Upadacitinib on Quality of Life and Work Productivity in Active Non-radiographic Axial Spondyloarthritis: Results From Randomized Phase 3 Trial SELECT-AXIS 2. Rheumatol Ther 2023; 10:887-899. [PMID: 37191738 PMCID: PMC10186301 DOI: 10.1007/s40744-023-00550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION To evaluate the effect of upadacitinib vs. placebo on health-related quality of life (HRQoL) and work productivity in patients with active non-radiographic axial spondyloarthritis (nr-axSpA) enrolled in the SELECT-AXIS 2 phase 3 randomized controlled trial. METHODS Adult patients with active nr-axSpA and an inadequate response to non-steroidal anti-inflammatory drugs were randomized 1:1 to receive upadacitinib 15 mg once daily or placebo. Mean changes from baseline in measures of HRQoL (Ankylosing Spondylitis QoL [ASQoL], Assessment of SpondyloArthritis international Society Health Index [ASAS HI], Short-Form 36 Physical Component Summary [SF-36 PCS] score) and Work Productivity and Activity Impairment (WPAI) were assessed through 14 weeks based on mixed-effects repeated measures or analysis of covariance models. The proportions of patients with improvements ≥ minimum clinically important differences (MCID) were assessed in HRQoL measures at week 14 using non-responder imputation with multiple imputation. RESULTS At week 14, upadacitinib- vs. placebo-treated patients reported greater improvements from baseline in ASQoL and ASAS HI (ranked, P < 0.001) and in SF-36 PCS and WPAI overall work impairment (nominal P < 0.05). Improvements were observed as early as week 2 in ASAS HI. Greater proportions of upadacitinib vs. placebo-treated patients reported improvements ≥ MCID in ASQoL (62.6 vs. 40.9%), ASAS HI (44.8 vs. 28.8%), and SF-36 PCS (69.3 vs. 52.0%), with numbers needed to treat < 10 for all (nominal P ≤ 0.01). Improvements ≥ MCID were consistently observed irrespectively of prior exposure to tumor necrosis factor inhibitors. CONCLUSIONS Upadacitinib provides clinically meaningful improvements in HRQoL and work productivity in patients with active nr-axSpA. CLINICAL REGISTRATION NUMBER NCT04169373, SELECT-AXIS 2.
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Affiliation(s)
- Uta Kiltz
- Ruhr-Universität Bochum, Bochum, Germany.
- Rheumazentrum Ruhrgebiet, Department of Rheumatology, Claudiusstr. 45, 44649, Herne, Germany.
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jessica A Walsh
- University of Utah and Salt Lake City Veterans Affairs Health, Salt Lake City, UT, USA
| | - Percival Sampaio-Barros
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (Including Nutrition Medicine), Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Walsh JA, Magrey MN, Baraliakos X, Inui K, Weng MY, Lubrano E, van der Heijde D, Boonen A, Gensler LS, Strand V, Braun J, Hunter T, Li X, Zhu B, León L, Marcelino Sandoval Calderon D, Kiltz U. Ixekizumab Improves Functioning and Health in the Treatment of Active Non-Radiographic Axial Spondyloarthritis: 52-Week Results, COAST-X Trial. Arthritis Care Res (Hoboken) 2020; 74:451-460. [PMID: 33044756 PMCID: PMC9306696 DOI: 10.1002/acr.24482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022]
Abstract
Objective To evaluate the effect of ixekizumab on self‐reported functioning and health in patients with active nonradiographic axial spondyloarthritis (SpA). Methods COAST‐X was a randomized, controlled trial conducted in patients with nonradiographic axial SpA over 52 weeks. Participants were randomized at a ratio of 1:1:1 to receive 80 mg of ixekizumab subcutaneously every 4 weeks or 2 weeks or placebo for 52 weeks. Self‐reported functioning and health end points included the Medical Outcomes Study Short Form 36 (SF‐36) health survey, Assessment of Spondyloarthritis International Society (ASAS) health index, and European Quality of Life‐5 Dimensions‐5 Level (EQ‐5D‐5L) health‐utility descriptive system. Results Compared to placebo, ixekizumab treatment resulted in improvement of SF‐36 physical component summary scores from baseline, with a score of 4.7 improving to 8.9 with ixekizumab therapy every 4 weeks (P < 0.05) and a score of 9.3 with ixekizumab therapy every 2 weeks (P < 0.01); the greatest improvements were observed in the domains of physical functioning, role‐physical, and bodily pain at weeks 16 and 52. A higher proportion of patients receiving ixekizumab therapy every 2 weeks reported ≥3 improvements based on the ASAS health index from baseline to weeks 16 and 52 (P < 0.05). Significantly more patients receiving ixekizumab every 4 weeks reported improvements in “good health status” on the ASAS health index (ASAS score of ≤5) at weeks 16 and 52 (P < 0.05). Patients receiving ixekizumab reported improvements on the EQ‐5D‐5L compared to those who received placebo at week 16 (0.11 versus 0.17 for patients receiving treatment every 4 weeks and 0.19 for patients receiving treatment every 2 weeks; P < 0.05), which remained consistent at week 52. There were no clinical meaningful differences in responses based on the ixekizumab dosing regimen for patients who received ixekizumab therapy every 2 weeks or every 4 weeks. Conclusion In patients with nonradiographic axial SpA, therapy with ixekizumab was superior to placebo in the improvement of self‐reported functioning and health at weeks 16 and 52.
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Affiliation(s)
- Jessica A Walsh
- University of Utah School of Medicine, Salt Lake City, UT, USA.,Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Marina N Magrey
- MetroHealth Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-University Bochum, Bochum, Germany
| | - Kentaro Inui
- Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Meng-Yu Weng
- National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Ennio Lubrano
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Annelies Boonen
- Maastricht University Medical Center, Maastricht, The Netherlands.,Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Vibeke Strand
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-University Bochum, Bochum, Germany
| | | | - Xiaoqi Li
- Eli Lilly and Company, Indianapolis, IN, USA, Herne
| | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA, Herne
| | - Luis León
- Eli Lilly and Company, Indianapolis, IN, USA, Herne
| | | | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Ruhr-University Bochum, Bochum, Germany
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Marin J, Acosta Felquer ML, Soriano ER. Spotlight on certolizumab pegol in the treatment of axial spondyloarthritis: efficacy, safety and place in therapy. Open Access Rheumatol 2018; 10:33-41. [PMID: 29765257 PMCID: PMC5944451 DOI: 10.2147/oarrr.s116654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Certolizumab pegol (CZP) is a pegylated humanized tumor necrosis factor-α inhibitor (TNFi) approved for the treatment of ankylosing spondylitis (AS) in the USA and for AS and non-radiographic axial spondyloarthritis (nr-axSpA) in Europe and in some Latin American countries. CZP lacks Fc region, preventing complement fixation and cytotoxicity mediated by antibody; CZP does not actively cross the placenta, unlike other TNFi. RAPID-axSpA study is a Phase III trial conducted in patients with AS and nr-axSpA as double blind and placebo controlled to week 24, dose blind to week 48 and open label to week 204. Of a total of 325 patients recruited, 107 patients were assigned to placebo and 218 patients to CZP (111 to CZP 200 mg Q2W, 107 to CZP 400 mg Q4W). Improvements in axial involvement, joint involvement, enthesitis and quality of life were reported in patients treated with CZP. Safety profile was like that reported for other TNFi in axSpA patients. In this article, we summarized the pharmacology and we reviewed the efficacy and tolerability of this drug for the treatment of axSpA. Some special considerations of CZP during pregnancy are included. CZP, the latest TNFi to be approved, showed efficacy in all manifestations of AS and nr-axSpA.
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Affiliation(s)
- Josefina Marin
- Rheumatology Unit, Internal Medical Serivces, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María Laura Acosta Felquer
- Rheumatology Unit, Internal Medical Serivces, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medical Serivces, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Hammoudeh M, Abdulaziz S, Alosaimi H, Al-Rayes H, Aldeen Sarakbi H, Baamer M, Baraliakos X, Dahou Makhloufi C, Janoudi N, Shirazy K, Sieper J, Sukhbir U. Challenges of diagnosis and management of axial spondyloarthritis in North Africa and the Middle East: An expert consensus. J Int Med Res 2016; 44:216-30. [PMID: 26811411 PMCID: PMC5580068 DOI: 10.1177/0300060515611536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/21/2015] [Indexed: 12/17/2022] Open
Abstract
Axial spondyloarthritis (SpA) is a spectrum of inflammatory disease with stages characterized by both nonradiographic and radiographic sacroiliitis. Nonradiographic axial SpA is associated with health-related quality-of-life impairment and may progress to ankylosing spondylitis. Axial SpA has a low prevalence in some countries in North Africa and the Middle East, and pooling of data and resources is needed to increase understanding of the regional picture. Early diagnosis and effective treatment are required to reduce disease burden and prevent progression. Anti-TNF therapy is recommended for patients with persistently high disease activity despite conventional treatment, and has been shown to be effective in patients without radiographic damage. Diagnostic delays can be an obstacle to early treatment and appropriate referral strategies are needed. In some countries, restricted access to magnetic resonance imaging and anti-TNF agents presents a challenge. In this article, a group of experts from North Africa and the Middle East evaluated the diagnosis and management of axial SpA with particular reference to this region.
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Affiliation(s)
- Mohammed Hammoudeh
- Department of Medicine, Weill Cornell Medical College Qatar, Hamad Medical Corporation, Doha, Qatar
| | | | - Hanan Alosaimi
- Rheumatology Section, Department of Internal Medicine/Rheumatology, Military Hospital, Jeddah, Saudi Arabia
| | - Hanan Al-Rayes
- Department of Medicine, Armed Force Hospital, Riyadh, Saudi Arabia
| | | | - Matouqa Baamer
- Department of Medicine, King Abdulaziz Hospital and Oncology Centre, Jeddah, Saudi Arabia
| | | | | | - Nahid Janoudi
- Department of Rheumatology, DSFH Hospital, Jeddah, Saudi Arabia
| | | | - Joachim Sieper
- Klinikum Benjamin Franklin, Freien Universität Berlin, Berlin, Germany
| | - Uppal Sukhbir
- Rheumatology Division, University Hospital, Sharjah, United Arab Emirates
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