Challenges and Advances in Targeting Remission in Axial Spondyloarthritis
Bibliographic record
Abstract
Biologic therapies have vastly improved clinical outcomes for patients with axial spondyloarthritis (axSpA). Consequently, targeting clinical remission/inactive disease is now a major treatment goal as outlined in current treat-to-target recommendations1,2. In March 2016, the current status of treating to target and aiming for remission in axSpA was reviewed by 7 expert rheumatologists and 1 patient representative at an industry-sponsored roundtable discussion. This editorial summarizes the key findings from the meeting and recommendations for future research. At present, there is no clear, universally accepted definition of remission in axSpA for both clinical trials and routine practice. Clinical remission/inactive disease is defined by the absence of clinical and laboratory evidence of significant inflammatory disease activity in current treat-to-target recommendations1,2; however, it remains unclear how to precisely assess this in practice. Various criteria to measure low disease activity (LDA) and clinical remission have been proposed that while potentially serving as realistic treatment goals in a treat-to-target strategy, require further validation in the clinical setting3,4. In 2001, the Assessment of Spondyloarthritis international Society (ASAS) developed a preliminary definition of clinical remission—ASAS partial remission (ASAS PR), which includes assessment of 4 domains: patient global, spinal pain, physical function, and “inflammation” (a proxy for true inflammation, based on morning stiffness)5. In clinical trials, 12–15%5,6 of patients with ankylosing spondylitis (AS) receiving nonsteroidal antiinflammatory drugs (NSAID) achieve partial remission; a ceiling of ∼15–40% at 6 months also exists with biologic therapies, including tumor necrosis factor (TNF) inhibitors and secukinumab7,8 (Table 19–20). Treating patients with short symptom duration may increase the proportion of patients reaching clinical remission to ∼50%9,21,22. View this table: Table 1. Achievement of ASAS partial remission and ASDAS inactive disease with … Address correspondence to Dr. X. Baraliakos, Associate Professor, Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649 Herne, Germany. E-mail: xenofon.baraliakos{at}elisabethgruppe.de
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.048 | 0.058 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.008 | 0.014 |
| Open science | 0.003 | 0.005 |
| Research integrity | 0.009 | 0.020 |
| Insufficient payload (model declined to judge) | 0.008 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".