First Biologic Drug Persistence in Patients With Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: A Real-World Canadian Physicians' Experience. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Ngo, Minh-Duc; Zummer, Michel; Andersen, Kathleen M.; Richard, Nicolas
• Is Part Of: Journal of clinical rheumatology. Volume 28:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: ankylosing spondylitis -- nonradiographic spondyloarthritis -- biological therapy -- drug utilization -- BASDAI; Rheumatism -- Periodicals; Rheumatology -- Periodicals; Musculoskeletal system -- Diseases -- Periodicals; Musculoskeletal Diseases -- Periodicals; Rheumatic Diseases -- Periodicals; Rhumatisme -- Périodiques; Rhumatologie -- Périodiques; Appareil locomoteur -- Maladies -- Périodiques; Musculoskeletal system -- Diseases; Rheumatism; Rheumatology; Periodicals; 616.723005
• DOI: 10.1097/RHU.0000000000001693
• Languages: English
• ISSNs: 1076-1608

Abstract

Background/Objectives: Axial spondyloarthritis (axSpA) includes ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA). Both are managed with biologic therapies; however, there is a lack of evidence for nr-axSpA therapies. The primary objective was to compare persistence to first biologic between AS and nr-axSpA patients in a longitudinal cohort. Secondary objectives were to examine disease activity markers over time and to evaluate predictors for drug discontinuation. Methods: Data were obtained from persons enrolled in the SpondyloArthritis Research Consortium of Canada registry between 2003 and 2018. Kaplan-Meier curves were constructed from the time of biologic initiation until discontinuation and compared using the log-rank test. Subanalyses were performed according to calendar year and disease activity. Cox proportional hazards models were used to identify factors associated with discontinuation. Results: We identified 385 biologic-naive persons. Overall, the 349 AS participants had longer persistence to their first biologic than the 36 nr-axSpA subjects ( p < 0.01). The Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index decreased by 2.3 points (95% confidence interval [CI], 1.9–2.7) and 3.2 points (95% CI, 2.6–3.7), respectively, in the first year and were stable thereafter. Adjusting for sex, human leukocyte antigen B27, and smoking status, nr-axSpA patients were more likely to discontinue their biologic than AS patients (hazards ratio, 1.65; 95% CI, 1.03–2.62). Conclusions: In this real-world study, AS patients had longer persistence to their first biologic compared with nr-axSpA, with disease subtype being the most significant predictor of treatment persistence. Future studies should be targeted at assessing long-term clinical outcome of axSpA in the real-world setting. Abstract : Supplemental digital content is available in the text.