Approaches to AxSpA Management, with Nigil Haroon, MD, PhD

In an interview with HCPLive, Nigil Haroon, MD, PhD, president of the Canadian Rheumatology Association and the head of the Division of Rheumatology at the University Health Network and Sinai Health, discusses his 2024 CCR East presentation regarding developments in axSpA. He emphasized understanding the "window of opportunity" is crucial in treating axial spondyloarthritis (axSpA).

Observational and cohort studies show that early treatment significantly increases the likelihood of remission or minimal disease activity. For instance, Haroon explained patients treated within the first 5 years of the disease have a much higher chance of positive outcomes compared to those treated after ten years. Early treatment also helps reduce disease progression, such as spinal fusion, and can potentially decrease cardiovascular complications. Additionally, initiating treatment early increases the chances of dose reduction or even stopping treatment when remission is achieved.

In the last 5 to 10 years, research has indicated the disease-modifying potential of early and effective treatment. Previously thought to be a relentless disease, clinicians now know treating axSpA early can indeed slow or stop disease progression, reducing disability and cardiovascular risks over time.

Another significant advancement is the concept of switching treatments. If a patient experiences primary failure with 1 agent, switching to another within the same mechanism of action is less effective. For example, if a patient fails on infliximab, switching to another tumor necrosis factor (TNF) inhibitor like adalimumab is less likely to succeed. It is better to switch to a different mechanism, such as an interleukin (IL)-17 inhibitor.

Haroon said personalized medicine is the ultimate goal, aiming to match the right drug to the right patient at the right stage of the disease. While there are indicators of disease severity, such as C-reactive protein (CRP) levels and spinal fusion on X-rays, providers still lack precise methods to select the optimal treatment.

Disclosures: Haroon is associated with AbbVie, Janssen, and Novartis.