TNF Inhibitor linked to Remission in Early axSpA regardless of Gut Inflammation: Study

A new study published in the journal of Arthritis & Rheumatology showed that early treatment with a TNF inhibitor led to remission in most patients with active axial spondyloarthritis (axSpA), regardless of baseline gut inflammation. Intestinal inflammation did not impact sustained remission rates, and about 75% of patients relapsed after stopping treatment.

The patients with spondyloarthritis experience pauci-articular peripheral arthritis or enthesitis, as well as inflammatory back discomfort. Long-term osteoproliferation and ankylosis of the spine and sacroiliac joint can result from persistent inflammation of the axial skeleton. Remarkably, those with persistent intestinal inflammation were more likely to begin anti-TNFα treatment and had a greater chance of developing ankylosing spondylitis (AS). Thus, to assess the effectiveness of tight-control, quick escalation to TNF suppression in early axial spondyloarthritis in connection to gut inflammation, this study was carried out.

The GO-GUT trial was conducted in treatment-naïve axSpA patients with high disease activity and symptom duration of less than a year. The patients had ileocolonoscopies at baseline, and the gut mucosa was examined histopathologically. After that, each patient got two separate NSAIDs at the recommended dosage for four weeks. Monotherapy with 50 mg golimumab every 4 weeks was started if inactive disease (defined as Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP <1.3) or clinically significant improvement (ΔASDAS-CRP score > 1.1 resulting in low disease activity (ASDAS-CRP <2.1)) could not be obtained.

The patients were monitored until the completion of the experiment or maintained clinical remission (ASDAS-CRP <1.3 at two consecutive visits spaced 12 weeks apart). All medication was stopped after a prolonged clinical remission was achieved, and the prospect of a drug-free remission was assessed.

The trial involved a total of 58 patients. In 28.6% of patients, there was microscopic intestinal inflammation, primarily acute inflammation. It was necessary to escalate treatment to golimumab for 72.7% of patients. Regardless of gut inflammation, 61.8% of patients achieved the primary trial objective of prolonged clinical remission. 78.1% of patients experienced a disease recurrence within a year after stopping treatment.

Overall, regardless of whether microscopic gut inflammation is present or not, a treat-to-target strategy can elicit high percentages of durable clinical remission in treatment-naïve early axSpA.

Reference:

Łukasik, Z., De Craemer, A.-S., Renson, T., Deroo, L., Varkas, G., de Hooge, M., Lenaerts, J., Hoorens, A., Cuvelier, C., Ortega, T. L., Carron, P., Van den Bosch, F., & Elewaut, D. (2025). Efficacy of golimumab in early axial spondyloarthritis in relation to gut inflammation (GO-GUT), an early remission induction study. Arthritis & Rheumatology. https://doi.org/10.1002/art.43283