SAT0285 Efficacy of early versus delayed initiation of anti-tnf-alpha treatment in axial spondyloarthritis. data from the czech registry attra. (12th June 2018)

• Record Type: Journal Article
• Authors: Mann, H.; Bubová, K.; Závada, J.; Forejtová, Š.; Křístková, Z.; Szczuková, L.; Horák, P.; Vencovský, J.; Pavelka, K.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1006
• Page End: 1006
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.3610
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Anti-TNF-α agents are the mainstay of pharmacotherapy for patients with axial spondyloarthritis (AxSpA) who failed treatment with NSAIDs. A little is known about the influence of early versus delayed treatment initiation on their clinical efficacy. Objectives: To compare change of disease activity in AxSpA patients on anti-TNF-α therapy based on symptom duration prior to treatment initiation. Methods: Baseline demographic data and efficacy parameters of patients starting their first anti-TNF-α treatment ≤10 years (EARLY) or >10 years (DEALYED) after first symptoms of AxSpA from the Czech national registry ATTRA were compared. Mean ±SD and absolute/relative frequencies were used to describe continuous and categorical variables, respectively. P-value of Fisher's exact test and Mann-Whitney test is given when assessing difference between groups in categorical and continuous variables. ATTRA is a centralised prospective computerised registry of patients receiving bDMARD therapy for rheumatic diseases collecting data on efficacy, safety and quality of life of all patients treated in the Czech Republic. Anti-TNF-α therapy was indicated for patients with AxSpA who have failed treatment with NSAIDs with CRP ≥1 mg/dl and BASDAI score ≥4. Results: Data from 1290 axSpA patients were available for analysis. 618 patients started treatment ≤10 years (EARLY) and 672>10 years (DELAYED) after the onset of AxSpA symptoms. There was no significant difference in gender distribution (71.4 vs 72.5% males; p=0.67) or age at AxSpA diagnosis (33.3±10.4 vs 33.5±10.4; p=0.68) between the two groups. At the time of anti-TNF-α initiation EARLY patients were significantly younger (36.4±10.6 vs 44.0±11.2 years; p<0.001) with shorter symptom duration (5.5±2.7 vs 18.9±8.1; p<0.001), but disease activity assessed by BASDAI (6.3±1.8 vs 6.3±1.6; p=0.81) and serum CRP levels (2.6±2.5 vs 2.4±2.0 mg/dL; p=0.34) were comparable in both groups. Mean change of BASDAI scores from baseline during anti-TNF-α therapy was significantly greater in the EARLY group at all time-points (3.7±2.5 vs 3.4±2.2 at month 3, 4.2±2.5 vs 3.8±2.3 at month 6, 4.4±2.5 vs 4.0±2.3 at month 12 and 4.4±2.5 vs 4.0±2.4 at month 24; p<0, 05 for all) suggesting better treatment response. The difference in survival on therapy between the two groups was not statistically significant. Conclusions: AxSpA patients starting anti-TNF-α therapy more than 10 years after onset of symptoms have significantly worse response to treatment compared to patients with earlier treatment initiation. Acknowledgements: This study was supported by the project of MHCR for conceptual development of research organisation 00023728 Disclosure of Interest: None declared