Background RCTs indicate a stable efficacy of TNF-inhibitors for patients with axial Spondyloarthritis (ax-SpA). However, this may not necessarily reflect the situation encountered in an ordinary clinical practice.
Objectives We report drug survival of sequential TNF-inhibitors in patients with axial SpA.
Methods We identified patients with ax-SpA who have been treated with TNF-inhibitors. Termination and/or change of therapy had been registered in our database. We performed survival analysis (KM), and survival time for sequential therapeutic regimens were compared using a Wilcoxon analyses.
Results We identified 393 patients with axial SpA who started treatment with their first TNF-inhibitor. During the first year of therapy 134 (36 %) pts stopped the treatment. The proportion of pts continuing therapy after the first year and the subsequent 5 years was higher than 83 % for each year, and the cumulative drug survival seemed to reach a plateau after 5 years at 40 %. 128 pts started their second and 47 pts started their third or more TNF-inhibitor, and within the first year 59 (46.1%) and 14 (27.7 %), discontinued. Overall drug survival was significantly higher for the first TNF-inhibitor compared to the second (Wilcoxon statistic = 9.187, p=0.002).
Conclusions In an ordinary clinical setting, patients with ax-SpA have a significantly reduced drug survival for the subsequent TNF-inhibitor if they fail on, or do not tolerate, the first drug. For each sequence, the first year of treatment had the highest termination rate.
Sieper J, van der Heijde D, Dougados M, et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis. 2012 Jul 7.
Disclosure of Interest None Declared