Key clinical point: In nonradiographic axial spondyloarthritis (nr-axSpA), etanercept does not have significant benefit by 16 weeks when started in very early disease, and the majority of patients who achieved inactive disease on the drug and then stopped it experienced a flare within 40 weeks.

Major finding: Patients with suspected very early disease who took etanercept did not have a significantly greater rate of achieving a 20% improvement in Assessment of Spondyloarthritis International Society (ASAS 20) response criteria at week 16 than did those taking placebo (17% vs. 11%; hazard ratio, 2.1; P = .2). In a separate trial, 75% of patients who achieved inactive disease with etanercept and then stopped the drug had a flare within 40 weeks, but 62% of this group were able to regain disease inactivity within 12 weeks of restarting etanercept.

Study details: A randomized, placebo-controlled PrevAS trial involved 80 patients with suspected very early nr-axSpA who started either etanercept or placebo, and the multicenter, open-label, phase 4 RE-EMBARK trial involved 119 patients achieving inactive nr-axSpA on etanercept.

Disclosures: The PrevAS trial was financially supported by Pfizer and ReumaNederland. Ms. Rusman declared no relevant conflicts of interest; four coauthors reported financial relationship(s) with Pfizer and other pharmaceutical companies. The RE-EMBARK trial was sponsored by Pfizer. Dr. Van den Bosch disclosed receiving grant/research support from AbbVie, Merck, and UCB and consulting fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB. Four coauthors reported financial ties to Pfizer and other pharmaceutical companies, and five coauthors were employees and shareholders of Pfizer.