Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis

Shim, J., Dean, L. E., Karabayas, M., Jones, G. T., Macfarlane, G. J. and Basu, N. (2020) Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: results from the BSRBR-AS registry and meta-analysis. Rheumatology, 59(11), pp. 3408-3414. (doi: 10.1093/rheumatology/keaa132) (PMID:32337555) (PMCID:PMC7590410)

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Abstract

Objectives: Effective management of axial spondyloarthritis (axSpA)-related fatigue is a major unmet clinical need. Anti-TNF therapy may reduce fatigue levels, although any effect has yet to be definitively quantified and predictors of any such improvements are unknown. Methods: The British Society of Rheumatology Register in Axial Spondyloarthritis (BSRBR-AS) prospectively recruited axSpA patients across the UK. Changes in fatigue levels (measured using the Chalder Fatigue Scale) >1 year were compared between those starting anti-TNF therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results were meta-analysed with the extant literature to calculate pooled estimates. Then, among those BSRBR-AS anti-TNF commencers with clinically relevant fatigue, baseline predictors of response were investigated. Results: Of the 998 BSRBR-AS recruits with complete fatigue data, 310 were anti-TNF commencers. At 1-year follow-up, the former group reported a mean fatigue change of −2.6 (95% CI −4.1, −1.9) points while the latter reported a mean worsening of fatigue by 0.2 points. Following propensity score adjustment, those commencing anti-TNF therapy reduced fatigue by 3.0 points compared with those not. Of those with significant fatigue and commencing anti-TNF, poor sleep quality at baseline predicted fatigue improvement. In the meta-analysis, including 1109 subjects, treatment with anti-TNF therapy resulted in a significant improvement in fatigue [Standardized mean difference (SMD) = 0.36, 95% CI 0.15, 1.56]. Conclusion: Anti-TNF therapy results in a significant but modest reduction in fatigue amongst axSpA patients, with those reporting poor sleep quality most likely to report improvement. Effective management will likely require additional approaches.

Item Type:Articles
Additional Information:This work was supported by the British Society for Rheumatology (BSR) who have funded the BSRBR-AS. The BSR received funding for this from Pfizer, AbbVie and UCB. Analysis of data was supported by the Versus Arthritis/Medical Research Council Centre for Musculoskeletal Health and Work [grant number 20665].
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Basu, Professor Neil
Authors: Shim, J., Dean, L. E., Karabayas, M., Jones, G. T., Macfarlane, G. J., and Basu, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Rheumatology
Publisher:Oxford University Press
ISSN:1462-0324
ISSN (Online):1462-0332
Published Online:26 April 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Rheumatology 59(11): 3408-3414
Publisher Policy:Reproduced under a Creative Commons licence

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