Observational studyRMD open2026
Impact of C reactive protein on effectiveness of interleukin-17 and tumour necrosis factor inhibitors in axial spondyloarthritis: a Danish nationwide observational study.
Observational study in RMD open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo study the impact of C reactive protein (CRP) level at treatment start on interleukin-17 inhibitor (IL-17i) and tumour necrosis factor inhibitor (TNFi) effectiveness, including treatment retention, in axial spondyloarthritis (axSpA).
methodsNationwide observational study including patients with axSpA from the DANBIO registry initiating their first IL-17i or first TNFi between 2015 and 2024. Outcomes were 12-month treatment retention and Bath Ankylosing Spondylitis Disease Activity Index remission stratified by CRP levels (<5 (low)/5-10 (intermediate)/>10 mg/L (high)) at treatment initiation (baseline). Kaplan-Meier plots (including substratification by sex and radiographic status) and Cox regression models were used to assess treatment retention and hazard of discontinuation for IL-17i and TNFi separately.
resultsOverall, 3387 patients were included (601 IL-17i, 2786 TNFi) with baseline CRP levels (low/intermediate/high) 57%/17%/26% for IL-17i and 48%/20%/32% for TNFi. For IL-17i, 95% of patients were TNFi-experienced; for TNFi, 99% were biologic-naïve.The 12-month retention rates stratified by baseline CRP (low/intermediate/high) were 51%/53%/55% for IL-17i and 63%/66%/72% for TNFi, with similar results when stratified by sex and radiographic status. Cox models (reference: low CRP) showed no clear association between CRP level and treatment retention among patients receiving IL-17i (intermediate CRP: HR 0.96, 95% CI 0.68 to 1.19; high CRP: HR 0.90, 95% CI 0.68 to 1.19). In contrast, among patients receiving TNFi, intermediate and high CRP levels were associated with a lower risk of treatment discontinuation (HR 0.86, 95% CI 0.73 to 1.02 and HR 0.72, 95% CI 0.62 to 0.84, respectively). Remission rates were 6%/8%/11% for IL-17i and 19%/22%/32% for TNFi.
conclusionIn routine care, IL-17i was mainly used in biologic-experienced patients, whereas TNFi was primarily used in biologic-naïve patients with axSpA. Higher baseline CRP levels were associated with higher retention for first TNFi but not for first IL-17i. Higher CRP was associated with higher remission rates for both IL-17i and TNFi.
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