Is treatment in patients suspected of non-radiographic Axial
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A Study was conducted to investigate the efficacy of 16 weeks treatment with etanercept (ETN), in patients suspected of non-radiographic-axial spondyloarthritis (nr-axSpA).

TNF inhibitor (TNFi) naive patients with inflammatory back pain (IBP) with at least two SpA features and high disease activity (Bath Ankylosing Spondylitis Disease Activity Index more than 4) and without the requirement of positive MRI and/or elevated (CRP), were randomized (1:1) to ETN (n=40) or placebo (PBO) (n=40) for 16 weeks and followed thereafter without study medication up to 24 weeks.

Primary endpoint was the Assessment of SpondyloArthritis international Society 20 (ASAS20) response at 16 weeks. Secondary endpoints included ankylosing spondylitis disease activity score (ASDAS), change in mean disease parameters and Spondyloarthritis Research Consortium of Canada (SPARCC) index scores of the MRI-SIJ, after 16 and 24 weeks.

Results:
Patient characteristics at baseline were comparable between ETN and PBO.
--At 16 weeks, no significant difference was observed in ASAS20 response between ETN (n=6, 16.7%) and PBO (n=4, 11.1%) (RR: 0.7). Only ESR level (-2.2 vs -1.4) showed more improvement (non-significant) in the ETN group compared to PBO at 16 weeks.
--Between 16 and 24 weeks, without study medication, the BASMI, CRP (significant) and ESR level showed a worsening of scores in ETN group compared to PBO.

Conclusively, this study shows that in patients suspected of nr-axSpA with high disease activity but without the requirement of positive MRI and/or elevated CRP treatment with etanercept is not effective.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1002/art.41607
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