{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:27:55Z","timestamp":1778495275267,"version":"3.51.4"},"reference-count":24,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,6,28]],"date-time":"2018-06-28T00:00:00Z","timestamp":1530144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Lack of response to tumor necrosis factor inhibitor (TNFi) agents is not uncommon, encountered during the treatment of axial spondyloarthritis (SpA) patients, and it can be classified as primary lack of response (PLR) or secondary lack of response (SLR). The primary aim of this study was to evaluate factors associated with TNFi failure types and their characteristics in axial SpA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult axial SpA patients who were TNFi naive at the time of baseline evaluation and started receiving their first biologics for active axial disease were identified. Based on the clinical response to the first TNFi, patients were then stratified into 3 groups: PLR, SLR, and responders. Clinical, demographic, and laboratory data were collected and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was a total of 249 axial SpA patients in the study (70.7% male, mean \u00b1 SD age 37.3 \u00b1 12.4 years), which included PLR (n = 62), SLR (n = 93), and responders (n = 94). PLR patients tended to be older, with a lower HLA\u2013B27 rate, a higher percentage of nonresponder axial SpA patients, and a higher baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score compared to SLR patients or responders. In multiple regression analysis, increasing age, negative HLA\u2013B27, higher baseline BASDAI, and treatment with the soluble TNF receptor protein were the independent predictors of PLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PLR accounted for nearly 40% of the TNFi failures in axial SpA patients. Older age, negative HLA\u2013B27, higher baseline disease activity, and treatment with soluble TNF receptors were the independent predictors of the primary nonresponse to TNFi.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23465","type":"journal-article","created":{"date-parts":[[2017,11,10]],"date-time":"2017-11-10T15:06:42Z","timestamp":1510326402000},"page":"1393-1399","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Profiling Response to Tumor Necrosis Factor Inhibitor Treatment in Axial Spondyloarthritis"],"prefix":"10.1002","volume":"70","author":[{"given":"Mansour","family":"Alazmi","sequence":"first","affiliation":[{"name":"Toronto Western Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7737-4180","authenticated-orcid":false,"given":"Ismail","family":"Sari","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada and Dokuz Eylul University, School of Medicine Izmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharath","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert D.","family":"Inman","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3210-4771","authenticated-orcid":false,"given":"Nigil","family":"Haroon","sequence":"additional","affiliation":[{"name":"Toronto Western Hospital and Krembil Research Institute University Health Network University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,6,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.108233"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.21563"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23969"},{"key":"e_1_2_7_5_1","first-page":"1010","article-title":"Switching between tumour necrosis factor blockers in spondyloarthritis: a retrospective monocentre study of 222 patients","volume":"29","author":"Dadoun S","year":"2011","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-014-0598-0"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0131864"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.131797"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev001"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2015.63"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210770"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22708"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.110767"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780270401"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-201933"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2014.29.9.1205"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-016-0969-2"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200882"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.150372"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.124446"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.016386"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.081048"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205322"},{"key":"e_1_2_7_24_1","first-page":"CD005468","article-title":"TNF\u2010alpha inhibitors for ankylosing spondylitis","author":"Maxwell LJ","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-009-1157-3"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.23465","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.23465","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:29:00Z","timestamp":1759418940000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.23465"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,28]]},"references-count":24,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1002\/acr.23465"],"URL":"https:\/\/doi.org\/10.1002\/acr.23465","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,28]]},"assertion":[{"value":"2017-07-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}