Background The Assessment of SpondyloArthritis International Society (ASAS) has recently updated recommendations for the use of anti-TNF in patients (pts) with axial SpondyloArthritis (axSpA), which include ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA).¹ Similarly, the ASAS/EULAR recommendations for management of AS were also updated.²

Objectives This analysis of the MAXIMA (Management of AXial SpA International and Multicentric Approaches) survey seeks to understand whether disease management differs between academic and community rheumatologists, and between US and international (all countries excluding US), rheumatologists.

Methods The MAXIMA survey was completed by 654 rheumatologists from 43 countries in Europe, Latin America, and North America. The survey included questions pertaining to referral, diagnosis, and management of pts with axSpA. The survey was funded by AbbVie and conducted by a third-party vendor with guidance and approval of the questionnaire by a steering committee of SpA experts. Only US participants received compensation and responded to a modified version of the survey.

Results Academic and community rheumatologists’ treatment decisions were similar for AS and nr-axSpA pts regarding choice, duration, timing of change in therapy, and assessment of treatment efficacy; however, responses differed between international and US rheumatologists (Table). In treating pts with AS, 78% of international and 90% of US rheumatologists prescribe 1-2 courses of NSAIDs before considering a treatment class change. 61% of international and 75% of US rheumatologists would evaluate efficacy of NSAIDs after 1-3 months. International rheumatologists more frequently prescribe sulfasalazine for AS (academic 97%; community 96%) and nr-ax-SpA (92%, 93%) than methotrexate, whereas US rheumatologists prescribe sulfasalazine and methotrexate equally, whether for AS or nr-axSpA (Table). Monitoring disease activity in AS or nr-axSpA by measuring BASDAI was more frequent among international (academic: 92% and 88%; community: 91% and 84%) than US (academic: 26% and 21%; community: 25% and 24%) rheumatologists.

Conclusions Academic and community clinical practice rheumatologist management approaches to AS and nr-axSpA were similar, with some differences noted between international and US rheumatologists. Although there is no evidence for efficacy of DMARDs in the treatment of axSpA, the majority of rheumatologists participating in this survey still use DMARDs for axSpA.

References

1. van der Heijde et al. Ann Rheum Dis 2011;70(6):905-8.

2. Braun, et al. Ann Rheum Dis 2011;70(6):896-904.

Acknowledgements AbbVie was responsible for the survey funding, analysis, interpretation of data, and writing, reviewing, and approving the publication. Dianne Nguyen is being acknowledged for her significant contribution to this publication in her medical director role at Abbott. Medical writing support was provided by Benjamin Wolfe, PhD, and Douglas E. Dylla, PhD, of AbbVie.

Disclosure of Interest D. van der Heijde Grant/research support from: AbbVie, Amgen, AstraZeneca, BMS, Centocor, Chugai, Daiichi, Eli-Lilly, GSK, Janssen Biologics, Merck, Novartis, Novo-Nordisk, Otsuka, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB, and Vertex, Consultant for: AbbVie, Amgen, AstraZeneca, BMS, Centocor, Chugai, Daiichi, Eli-Lilly, GSK, Janssen Biologics, Merck, Novartis, Novo-Nordisk, Otsuka, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB, and Vertex, Employee of: Imaging Rheumatology bv, J. Sieper Grant/research support from: AbbVie, Merck, Pfizer, and UCB, Consultant for: AbbVie, Merck, Pfizer, and UCB, Speakers bureau: AbbVie, Merck, Pfizer, and UCB, D. Elewaut Grant/research support from: AbbVie, Consultant for: AbbVie, Speakers bureau: AbbVie, A. Pangan Shareholder of: AbbVie Inc., Employee of: AbbVie Inc.