TOPLINE:

Patients with very early axial spondyloarthritis (axSpA) who started a first TNF inhibitor within 1 year of the onset of back pain did not have better 1-year clinical outcomes or longer drug retention than those with established axSpA.

METHODOLOGY:

• Researchers conducted an observational study using a Swiss axSpA registry to assess whether initiating a first TNF inhibitor within 1 year of the onset of back pain led to better outcomes than starting therapy later when the disease is established.
• They analysed data of 3234 patients with axSpA between January 2004 and April 2025. Mean ages ranged between 37.5 and 43.3 years, and 46%-55% were men.
• Patients were categorised on the basis of the duration of back pain at inclusion or treatment start: those with very early axSpA (≤ 1 year), early axSpA (> 1 to ≤ 2 years), and established axSpA (> 2 years).
• The primary outcome was the achievement of low disease activity, marked by an axSpA Disease Activity Score (ASDAS) below 2.1 at 1 year after starting a first TNF inhibitor.
• The achievement of the ASDAS below 1.3, improvements in the ASDAS, the change in levels of C-reactive protein (CRP), and drug survival were also assessed.

TAKEAWAY:

• Overall, 138 of 441 patients with very early axSpA, 83 of 218 with early axSpA, and 928 of 2575 with established axSpA started their first TNF inhibitor after registry inclusion.
• At 1 year after starting the TNF inhibitor, the odds of achieving an ASDAS below 2.1 did not vary significantly between patients with very early and established axSpA.
• Drug retention rates were comparable between very early and established axSpA groups, with no significant difference seen in the risk for TNF inhibitor discontinuation.
• All axSpA groups showed similar reductions in CRP levels, despite higher levels in very early cases at baseline. Male sex and human leukocyte antigen B27 positivity predicted better responses and a lower risk for TNF inhibitor discontinuation.

IN PRACTICE:

"[The] study does not indicate higher TNFi [TNF inhibitor] effectiveness in patients who initiate treatment within 1 year of symptom onset compared with those who start therapy later," the authors of the study wrote.

SOURCE:

This study was led by Mauro Bachmann, University of Zürich, Zürich, Switzerland. It was published online on March 05, 2026, in RMD Open.

LIMITATIONS:

The study was observational and relied on the patient recall of symptom onset, potentially risking bias. MRIs were neither systematic nor centrally reviewed. All potential confounders could not be adjusted, and only short‐term outcomes were reported.

DISCLOSURES:

This study received funding from an anonymous patient donation via the USZ Foundation. The Swiss registry used for the study received support from multiple foundations and pharmaceutical companies. Several authors reported receiving grants, speaking fees, consulting fees, and/or honoraria from multiple pharmaceutical and healthcare companies. One author reported being the inventor of a patent and a co-founder of a biotechnology startup.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.