Rheumatology Practice Changers 2014

Bret S. Stetka, MD; Stephen A. Paget, MD


December 18, 2014

In This Article

New Strategies in Spondyloarthropathies

As in OA, a number of studies and advances from 2014 should help to improve management of the spondyloarthropathies.

Research[17] from The Netherlands published in Annals of the Rheumatic Diseases found that low levels of the TNF inhibitor etanercept are associated with high disease activity in patients with ankylosing spondylitis (AS), suggesting that perhaps some of the 40% of patients who do not respond to treatment might benefit from a dosage increase.

Also published in Annals of Rheumatic Diseases, the TOPAS proof-of-concept study[18] found that treatment of AS with the human monoclonal antibody ustekinumab is associated with a reduction in signs and symptoms of active disease and is well tolerated. Another monoclonal antibody, secukinumab, has also shown promise in AS. Data from the phase 3 MEASURE 1 trial[19] suggest that in patients with active AS, secukinumab treatments results in significant symptomatic improvement and is well tolerated.

Although neither of these drugs has been approved by the FDA and have to the clear the usual hurdles to do so, this gives hope to the sizable portion of patients with AS who do not improve on multiple anti-TNF medications. Long-term safety, clinical efficacy, and radiologic data are needed to assure us that these drugs might be as effective as the five approved anti-TNF agents have been.

Finally, similar to how treatment targets have been defined for such conditions as hypertension; diabetes; and, in rheumatology, RA, this year saw the first attempt to develop a treat-to-target strategy for SpA, including AS and PsA.[20] The specific recommendations are beyond the scope of this article; however, the authors defined the treatment target as remission or, alternatively, low disease activity, though they noted that future confirmatory research is necessary. The new guidance represents a major step toward optimal spondyloarthropathy care.


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