AxSpA Maintained OK via Remote Monitoring, Patient-Led Care

TOPLINE:

Remote monitoring and patient-initiated care matched usual care in maintaining low disease activity in patients with axial spondyloarthritis (axSpA) on stable TNF inhibitor therapy.

METHODOLOGY:

• Researchers conducted a randomized, noninferiority trial at a hospital in Norway between September 2021 and June 2022 to assess whether remote monitoring or patient-initiated care was noninferior to usual care in maintaining low disease activity in patients with axSpA.
• They enrolled 243 patients (mean age, 43 years; 75% men) with axSpA who had been on stable TNF inhibitor treatment for the past 6 months and had low disease activity (Axial Spondyloarthritis Disease Activity Score [ASDAS] < 2.1).
• Participants were randomly allocated to one of three groups:
  • Patient-initiated care (n = 81): This arm did not include scheduled visits. Patients submitted their outcomes via a mobile application and contacted the rheumatology nurse if they felt worse.
  • Remote monitoring (n = 80): This arm also did not include scheduled visits. A nurse reviewed the entries of patient-reported outcomes submitted through the application daily and decided whether an in-person visit was needed.
  • Usual care (n = 82): Standard practice was followed, with face-to-face nurse-led visits under rheumatologist supervision every 6 months.
• The primary outcome was the probability of achieving low disease activity compared between groups at 6, 12, and 18 months, with a 15% noninferiority margin.

TAKEAWAY:

• Both remote monitoring and patient-initiated care were noninferior to usual care, with estimated differences in the probability of achieving an ASDAS < 2.1 of -4.1% (97.5% CI, -9.9% to 1.8%) and -1.1% (97.5% CI, -7.2% to 4.9%), respectively.
• Patient-initiated care demonstrated noninferiority to remote monitoring, with a difference of 2.9% in the probability of achieving an ASDAS < 2.1 (95% CI, -1.5% to 7.4%).
• Secondary outcomes, including measures of disease activity, physical function, and patient satisfaction, were comparable across all groups, with ≥ 90% of patients reporting satisfaction.
• The number of adverse events was similar across groups. Few serious adverse events occurred, and none resulted in study discontinuation.

IN PRACTICE:

“The lower resource use in patient-initiated care can liberate time for healthcare providers to care for patients with high disease activity or more complex diseases and thus facilitate more targeted use of healthcare resources in rheumatology,” the authors wrote.

SOURCE:

This study was led by Inger Jorid Berg, MD, Diakonhjemmet Hospital, Oslo, Norway. It was published online on May 23, 2025, in Annals of the Rheumatic Diseases.

LIMITATIONS:

Selection bias may have influenced results as patients motivated for alternative follow-up were more likely to participate. The open-label design and reliance on patient-reported outcomes could have been influenced by participants’ enthusiasm for their assigned follow-up method. Using patient-reported outcomes as the main benchmark for clinical action in remote monitoring may affect interpretation of the results in this noninferiority trial. 

DISCLOSURES:

This study received funding from South-Eastern Norway Regional Health Authority and The Research Council of Norway. Three authors reported receiving research grants, consulting fees, or other forms of financial or nonfinancial support from pharmaceutical companies, including AbbVie, Amgen, Biogen, Janssen, MSD, Pfizer, and UCB.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.