Individualizing Nsaid Therapy in Axial Spondyloarthritis: N-of-1 Trials With Bayesian Analysis

Authors

• Mark C Hwang
• Seokhun Kim
• Shervin Assassi
• Reyna Chavez
• Joyce Samuel
• Charles Green
• Jon Tyson
• John Reveille

Language

English

Publication Date

12-1-2025

Journal

Rheumatology

DOI

10.1093/rheumatology/keaf393

PMID

40676732

PMCID

PMC12671866

PubMedCentral® Posted Date

12-13-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Objective: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the spine and sacroiliac joints. NSAIDs are first-line therapy, but individual responses vary widely. We evaluated the efficacy and patient preference of three NSAIDs (celecoxib, meloxicam and naproxen) through Bayesian N-of-1 clinical trials to optimize axSpA management.

Methods: We conducted N-of-1 trials with 42 patients meeting ASAS criteria for axSpA. Each patient was asked to complete two cycles of randomized double-blind crossover comparisons of the three NSAIDs, each for 4 weeks. The primary end point was the change in the Ankylosing Spondylitis Disease Activity Score (ASDAS). Bayesian analysis assessed the average treatment effect of each NSAID based on individual patient responses.

Results: Thirty patients completed the trial series. All three NSAIDs resulted in reductions in ASDAS overall across all individuals (posterior probability of benefit [PPB] >0.99 of >0 reduction). No single NSAID demonstrated superiority across all patients. Patient preferences varied, with individualized responses to NSAID therapy identified through Bayesian analysis. The preferred NSAID for each patient showed a larger reduction in ASDAS compared with the least effective NSAID (0.88 vs 0.12, PPB >0.99), with potential clinically important improvement (PPB [0.6] = 0.96).

Conclusions: Applying N-of-1 trials and Bayesian analysis effectively optimized NSAID therapy for axSpA in terms of efficacy and accounting for side effect profile. This approach raises the possibility of more efficient systemic individualization than usual care.

Keywords

Adult, Female, Humans, Male, Middle Aged, Anti-Inflammatory Agents, Non-Steroidal, Axial Spondyloarthritis, Bayes Theorem, Cross-Over Studies, Double-Blind Method, Meloxicam, Naproxen, Patient Preference, Precision Medicine, Severity of Illness Index, Treatment Outcome, axial spondyloarthritis, NSAIDs, N-of-1 trials, Bayesian analysis, ASDAS, patient preference, pragmatic clinical trials, personalized medicine, comparative effectiveness, shared decision-making

Comments

Trial registration: ClinicalTrials.gov NCT04115098.

Published Open-Access

yes

Recommended Citation

Hwang, Mark C; Kim, Seokhun; Assassi, Shervin; et al., "Individualizing Nsaid Therapy in Axial Spondyloarthritis: N-of-1 Trials With Bayesian Analysis" (2025). Faculty, Staff and Student Publications. 6849.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6849