Background Studies on drug survival in patients with spondyloarthritis (SpA) in a real-life context are scant.

Objectives We aimed to examine the real-life data of survival and the reasons for discontinuation or switching of biologic DMARDs (bDMARDs) in patients with axial and peripheral SpA (axSpA and pSpA).

Methods This is a single-center retrospective longitudinal study in adult consecutive patients with axSpA and pSpA according to ASAS criteria treated with at least one bDMARD. Data are presented as medians (interquartile range [IQR]) for continuous data or as numbers (percentages) for categorical variables. Drug survival distribution curves were computed by the Kaplan-Meier method.

Results A total of 141 patients (M/F: 72/69), median age 56 years [IQR 15], median disease duration 112 months [IQR 140] were enrolled. Among 57 patients with axSpA, 30 (53%) were HLA-B27-positive, 11 (19%) had had at least one uveitis episode, 4 (7%) were also affected by inflammatory bowel disease; 14 (24%) were taking NSAIDs and 2 (6%) glucocorticoids (GCs). Among 84 patients with pSpA, 50 (66%) were affected by psoriasis, 2 (5%) had had at least one uveitis episode; 16 (18%) were taking NSAIDs, 14 (16%) GCs and 33 (39%) csDMARD. The median duration of follow-up was 28 months (IQR 46). In the axSpA group, the median treatment duration was 32 months (IQR 60), while in the pSpA group was 25 months (IQR 37). Among axSpA patients, adalimumab (ADA) was the most common current bDMARD (58%) followed by etanercept (ETA) (28%), golimumab (GOL) (9%), ustekinumab (UST) (1%), and secukinumab (SEC) (4%). During a follow-up of five years, the comparison between survival curves of these bDMARDs showed significant differences (p= 0.015) (figure 1 A). The reasons for bDMARDs switching were primary failure (PF, 50%), secondary failure (SF, 25%), side effects (SE, 20% - mostly infections). In the pSpA groups, the most common current therapy was ADA (44%) followed by ETA (33%), SEC (12 %),GOL (6%), UST (5 %). As shown in figure 1 B, no significant differences (p= 0.49) in drug survival were found among patients treated with these bDMARDs. The reasons for bDMARDs switching were PF (38%), SF (38%), SE (8% - mostly infections).

Conclusion In our experience, ADA was the most frequently prescribed bDMARDs as the first choice in patients with axSpA and pSpA. Despite PF and SF being the main causes of treatment discontinuation, a second anti-TNF agent was the preferred option in most cases.

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REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests None Declared.