Background Many patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) do not receive advanced therapy (AT; a biologic or apremilast) or their first experience of AT is inadequate owing to lack of efficacy, intolerance or loss of benefit over time.
Objectives To describe use of AT, treatment failure and switching, and assess implications of failure.
Methods In this cross-sectional survey from five European countries and the USA, physicians with 3–30 years' experience were eligible if currently treating patients with AS or PsA. Physician-completed record forms included reasons for switching AT, including “primary lack of efficacy (PLE, initial non-response)” and “secondary lack of efficacy (SLE, loss of response over time)”. Patients reported HRQoL (EQ-5D and SF-36), work productivity and activity impairment (WPAI) and HAQ-DI (PsA only). At analysis, current AT was assessed as “failed” if, after ≥3 months, disease severity had worsened since AT initiation or had remained severe, or if the physician was dissatisfied with disease control, perceived disease activity as “unstable” or “deteriorating”, or did not consider treatment a “success”.
Results Data are presented from 599 physicians (457 EU/142 USA), 2018 patients with AS (1520/498) and 2436 with PsA (1839/597). Of 1889 AS patients with full treatment data, 33.5% had never received AT, 57.1% were receiving their first, 6.9% their second and 2.5% their third or later AT. Of the 2278 patients with PsA and full treatment data, the proportions were 40.8%, 48.0%, 7.9% and 3.2%, respectively.
Of the 190 AS patients with known reasons for switching from first AT, 15.8% switched owing to PLE and 46.8% to SLE. Of the 245 PsA patients, the proportions were 22.0% and 44.9%. Despite PLE, patients continued on first-line AT for a mean 12.1 months (AS, n=30) and 9.5 months (PsA, n=52).
The “failure” rate increased with successive ATs: 10.8% (116/1079) of AS patients on their first AT, 16.2% (21/130) on their second and 22.9% (11/48) on their third. For PsA, the rates were 11.0% (120/1094), 13.3% (24/181) and 19.2% (14/73).
AS patients failing AT had significantly worse EQ-5D utilities (0.55 vs 0.82) and SF-36 physical component summary (PCS; 45.9 vs 73.3), mental component summary (MCS; 57.5 vs 69.6) and social function scale (SF; 53.8 vs 75.2) scores than those not failing (all p<0.0001). PsA patients failing AT also had significantly worse EQ-5D (0.63 vs 0.80, p<0.0001), PCS (55.1 vs 73.9, p<0.0001), MCS (60.4 vs 67.9, p=0.0024) and SF (60.4 vs 75.0, p<0.0001) scores than those not failing. For AS failure, WPAI (44.0% vs 21.7%, p<0.0001) was higher, and for PsA failure, WPAI (29.7% vs 21.0%, p=0.0112) and HAQ-DI (0.96 vs 0.55, p<0.0001) were higher than non-failure.
Conclusions This large multinational survey in AS and PsA showed that the main reason for switching AT is lack of efficacy. Failure of AT has significant negative effects on HRQoL and work productivity.
Disclosure of Interest R. Alten Grant/research support from: Novartis, Speakers bureau: Novartis, V. Strand Consultant for: Abbvie, Amgen Corporation, AstraZeneca, BMS, Celgene, Celltrion, CORRONA, Genentech/Roche, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, Lilly, Novartis, Pfizer, Regeneron, Sandoz, Sanofi and UCB, P. Conaghan Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Pfizer and Roche, A. Deodhar Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Janssen, Novartis, Pfizer and UCB, Consultant for: AbbVie, Amgen, Boehringer Ingelheim, Janssen, Novartis, Pfizer and UCB, E. Sullivan Consultant for: Novartis, S. Blackburn Consultant for: Novartis, H. Tian Employee of: Novartis, K. Gandhi Shareholder of: Novartis, Employee of: Novartis, S. Jugl Shareholder of: Novartis, Employee of: Novartis