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Objective: considering the potential role of the gut microbiota in the pathophysiology of spondyloarthritis (SpA) as in the therapeutic response to biologics, we studied the influence of co-medications known to interfere with the microbiota with the therapeutic response to TNF-inhibitor (TNF-i) in SpA patients. Methods: this was a retrospective cohort including patients having axial SpA (ax-SpA). Patients were classified as responder (R) or non-responder (NR) according to the BASDAI (< 40/100) value at month 6 or to the clinician judgment. We collected co-medication administered 1 month before and during the first 3 months of the TNF-i treatment. A replication cohort was built for validation of the results. Multivariate logistic regression models adjusted for potential confounders were applied to evaluate the relationship between co-medications and TNF-i response. Results: we included 188 patients of whom 135 (72%) were considered as R. In univariate analysis, nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), antibiotics and psychotropic drugs intakes were significantly associated with a higher proportion of NR patients, unlike for corticosteroids, methotrexate (MTX), angiotensin-converting enzyme inhibitors and statins use. NSAIDs, PPIs and antibiotics intakes were considered as independent factors associated with TNF-i failure in multivariate analysis. 185 patients were included in the replication cohort, including 127 (69%) R patients. In multivariate analysis, although 88% of patients taking PPIs were also given NSAIDs, PPIs remained associated with a poorer response to a first TNF-i (p |
