Spondyloarthritis & psoriatic arthritis
Evaluation of the placebo and treatment effect overtime in randomised clinical trials evaluating the efficacy of biologics in axial spondyloarthritis: systematic review and meta-analysis
Authors' conclusion
ASAS20/40 treatment effects have declined over time in axSpA trials, consistent with a fading of reported effectiveness, whereas ASDAS-based endpoints remain stable, indicating greater robustness to placebo effects and temporal trends.
Study context
- Population
- RCTs in axial spondyloarthritis (axSpA), MEDLINE up to July 2024
- Participants
- 6,437 participants31 RCTs
- Comparison
- TNFi or IL-17 inhibitors vs placebo
- Outcome
- Temporal trends in placebo response for ASAS20/40, ASDAS Clinically Important Improvement and ASDAS-ID
- Follow-up
- Each trial's primary endpoint
Methodological detailsrandom-effects meta-regression, adjusted for age, sex, radiographic status, region, route of administration, baseline BASDAI, baseline CRP and disease duration, Two reviewers independently selected studies and extracted data
- Random-effects meta-regression
- Adjusted for age, sex, radiographic status, region, route of administration, baseline BASDAI, baseline CRP and disease duration
- Two reviewers independently selected studies and extracted data
Pooled result
As reported in the abstract
Temporal trends (annual change)
Treatment effect, ASAS20, per year
−5%
P < .001
Treatment effect, ASAS40, per year
−3.7%
P = .04
Placebo response, ASAS20, per year
+1%
P < .0001
Placebo ASDAS-ID, per year
+0.19%
P < .05
Original publication
Evaluation of the placebo and treatment effect overtime in randomised clinical trials evaluating the efficacy of biologics in axial spondyloarthritis: systematic review and meta-analysis. Ann Rheum Dis. Published 25 December 2025. doi:10.
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