PT - JOURNAL ARTICLE AU - Jürgen Braun AU - Xenofon Baraliakos AU - Uta Kiltz AU - Klaus Krüger AU - Gerd Rüdiger Burmester AU - Siegfried Wassenberg AU - Matthias H. Thomas TI - Rheumatologists use different cut offs for disease activity in real life – the experience with Golimumab in ankylosing spondylitis – Subanalysis from the Non-Interventional German GO-NICE study AID - 10.3899/jrheum.181040 DP - 2019 Mar 15 TA - The Journal of Rheumatology PG - jrheum.181040 4099 - http://www.jrheum.org/content/early/2019/03/18/jrheum.181040.short 4100 - http://www.jrheum.org/content/early/2019/03/18/jrheum.181040.full AB - Objective International recommendations for the management of axial spondyloarthritis including ankylosing spondylitis (AS) recommend a BASDAI level of disease activity of ≥4 to initiate treatment with biologics. We aimed to evaluate the level of disease activity used to initiate tumor necrosis factor inhibitor (TNFi) treatment and the level of responses to treatment based on different BASDAI cut-offs. Methods This is a posthoc analysis of the non-interventional, prospective, GO-NICE study in the subgroup of biologic-naïve AS treated with golimumab 50mg subcutaneously once monthly. Results Of the 244 biologic-naïve AS patients at baseline, 70.5% had a BASDAI ≥4 (Group 1), 14.3% 2.8 to <4 (Group 2), and 15.1% even <2.8 (Group 3). A total of 134 patients (54.9%) completed the 24-month observational period. The mean BASDAI in Groups 1, 2 and 3 was initially 5.9±1.3, 3.4±0.4 and 2.0±0.8, decreased to 2.2± 2.0, 1.9± 1.2 and 1.0 ± 1.2 within 3 months (all p<0.0001 vs. baseline), and decreased significantly to 2.2±1.7, 1.9±1.7 and 1.4±1.0 at month 24 (all p<0.005), respectively. BASDAI 50% improvement was noted in 68.8%, 44.8%, and 45.2% of patients at month 3, and in 84.9%, 61.9%, and 55.0% at month 24, respectively. Conclusion TNFi treatment was initiated in almost a third of AS patients with a lower disease activity states as assessed by BASDAI cut-off of ≥4. Patients with a BASDAI between 2.8 and <4 appeared to benefit significantly from golimumab treatment, while patients with BASDAI <2.8 did not. This finding should lead to a reevaluation of the established BASDAI cut-off of ≥ 4.