EIGHT OUT OF ten begin to feel bad before the age of thirty, with pain and stiffness at the bottom back that do not pass and are mistaken for a simple one low back pain, treated for months or years only with non-steroidal anti-inflammatory drugs, analgesics, and / or physical therapies: to arrive at the diagnosis of axial spondyloarthritis, a chronic inflammatory joint disease that affects over 200,000 patients in Italy, it takes an average of 7 years from the beginning of symptoms. Years in which the back becomes less and less flexible, from the cervical to the lumbo-sacral spine, while other joints such as the hip, shoulder, hands and feet can also be affected by inflammation, and therefore become painful with progressive loss of mobility and impairment of the quality of life.
Therapy
For patients, however, a new therapeutic weapon is coming, ixekizumab, an IL-17A antagonist developed by Lilly, which is able to stop the radiological progression of the disease (development of syndesmophytes, i.e. bone bridges between two vertebrae , with fusion of the spine), as well as maintaining long-term efficacy at 2 years, persistently removing inflammatory back pain, and allowing a continuous improvement in the quality of life of patients. The data are those of the COAST-Y study, just presented at the EULAR 2021 congress. The drug, used in patients who do not respond or cannot be treated with traditional treatments (called TNF inhibitors), had already obtained excellent results after first 16 weeks of administration and to an even greater extent after one year, showing that the positive effect on the disease is maintained over the long term. With ixekizumab at 16 weeks up to about 50% of patients with ankylosing spondylitis never treated with disease-modifying antirheumatic drugs, up to about 25% of those already treated with TNF, and up to 35% of patients with the non-radiographic form, achieves an improvement of at least 40% in the signs and symptoms of the disease (COAST-V and W data published in Ann Rheum Dis 2019 and COAST-X data The Lancet 2019).
In COAST-Y, long-term therapy, lasting up to 2 years in total, also allows in almost 90% of cases to block or slow down the progression of the disease evaluated by radiography.
Back pain: when it’s time to go to the rheumatologist
by Irma D’Aria
Pain
The positive effect on pain and disease activity also continues in the long term, which remains low in 47% of patients treated and is in partial remission in another 20% of cases, while 56% of patients have a symptom improvement of at least 40%. “Inflammatory low back pain is the first symptom of axial spondyloarthritis in most patients (about 3/4). Unfortunately, it is usually mistaken for ‘simple’ back pain and the diagnosis comes late, often when it is already there. it is a consistent impairment of functionality with fusion of the spinal column that becomes rigid and inflexible, acquiring the bamboo cane appearance:
not infrequently the therapy is started in advanced stages of the disease – explains the professor Carlo Salvarani, director of the Complex Structure of Rheumatology of the Polyclinic of Modena – The data presented on the new indication of this drug, which is already widely used for the treatment of other chronic inflammatory diseases and known for its good safety profile, are excellent news for these patients “.
Ache. A book teaches how to fight it
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Spondyloarthritis
The COAST-Y study involved 773 patients with axial spondyloarthritis who achieved disease remission with continued treatment for 52 weeks and were then randomized to discontinue or continue for up to 116 weeks. The data collected with ixekizumab support that long-term therapy is well tolerated and above all that it is able to block the progression of the disease leading to consistent and sustained long-term improvements in disease activity and quality of life in both patients. with the radiographic form as well as with the non-radiographic form.
Ache. A book teaches how to fight it
by Irma D’Aria
“This study clearly demonstrates that in the vast majority of patients with radiological axial spondyloarthritis who took ixekizumab for 2 years there was no significant radiological progression of spinal damage, both in ‘naive’ patients (never treated before, ed). to anti-TNF therapy and in those already treated with at least one anti-TNF – concludes Professor Salvarani – The data of the two studies therefore demonstrate that the response to treatment is lasting and effective with respect to both the improvement of the disease activity and quality of life as well as the inhibition of the progression of vertebral damage, thus strengthening the value of the drug already approved by the EMA for use in both radiographic and non-radiographic axial spondyloarthritis “.
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