Comorbidity and response to TNF inhibitors in axial spondyloarthritis: longitudinal analysis of the BSRBR-AS

Sizheng Steven Zhao, Gareth Jones, Gary Macfarlane, David M Hughes, Robert J Moots, Nicola J Goodson* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
1 Downloads (Pure)


Objective. Comorbidities influence disease assessment in axial spondyloarthritis (axSpA), but theirassociation with response to TNF inhibitors (TNFi) is unclear. We examined associations betweencomorbidity history at TNFi initiation and: 1) change in disease indices over time; 2) binary responsedefinitions; 3) time-to-treatment-discontinuation.Methods. We studied participants starting their first TNFi from a national axSpA register.Comorbidity categories were created from 14 physician-diagnosed conditions and compared against:change in disease indices over time using linear mixed effects models; BASDAI50/2 (50% or 2-unitreduction) and BASDAI<4 at 6 months using logistic models; and time-to-treatment-discontinuation using Cox models. Models were adjusted for age, gender, BMI, deprivation and education.Results. 994 were eligible for analysis (68% male, mean age 45 years); 21% had one comorbidity and 11% had ≥2. Baseline disease severity was higher in those with comorbidities across all indices, but absolute improvement over time was comparable for BASDAI and spinal pain. Participants with ≥2comorbidities had smaller absolute improvement in BASFI and quality of life. This group also had numerically reduced odds of achieving BASDAI50/2 (OR 0.81; 95%CI 0.45, 1.45) and BASDAI<4 (OR0.57; 95%CI 0.32, 1.04). Treatment discontinuation was increased in those with 2 comorbidities (HR1.32; 95%CI 0.88, 2.00) and ≥3 comorbidities (HR 2.18; 95%CI 1.20, 3.93) compared to none.Conclusions. Participants with multiple comorbidities had poorer treatment outcomes, particularlyincreased treatment discontinuation and poorer improvements in function and quality of life. These results inform clinicians and educate patients about response to the first TNFi given comorbidityburden.
Original languageEnglish
Article numberkeaa900
Pages (from-to)4158–4165
Number of pages8
Issue number9
Early online date28 Dec 2020
Publication statusPublished - 30 Sep 2021


  • axial spondyloarthritis
  • comorbidities
  • treatment response
  • TNF inhibitors
  • ankylosing spondylitis


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