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SAT0391 The 8-Year Retention Rate of The First TNF-Inhibitor in The Treatment of Spondyloarthropathies: Real-Life Data from A Multicentric Local Registries
  1. E.G. Favalli1,
  2. C. Selmi2,
  3. A. Becciolini1,
  4. M. Biggioggero3,
  5. A. Ariani4,
  6. D. Santilli4,
  7. E. Fusaro5,
  8. S. Parisi5,
  9. M. Massarotti6,
  10. A. Marchesoni1,
  11. P.L. Meroni7
  1. 1Department of Rheumatology, Gaetano Pini Institute, Milano
  2. 2Rheumatology, Humanitas Research Hospital, University of Milan, Rozzano
  3. 3Department of Clinical Sciences and Community Health, Division of Rheumatology, University of Milan and Gaetano Pini Institute, Milano
  4. 4Medicine Department, Internal Medicine and Rheumatology Unit, University Hospital, Parma
  5. 5Department of Rheumatology, Città Della Salute e della Scienza, Torino
  6. 6Rheumatology, Humanitas Research Hospital, Rozzano
  7. 7Department of Clinical Sciences and Community Health, University of Milan and IRCCS Istituto Auxologico Italiano, Milano, Italy

Abstract

Background Long-term data on drug survival of TNF inhibitors (TNFi) in the treatment of spondyloarthropathies are still lacking.

Objectives The aim of the study is to analyze in a setting of real-life the 8-year retention rate of the first TNFi for the treatment of psoriatic arthritis (PsA) and axial spondyloarthritis (ax-SpA) and to compare the between-group discontinuation rates for each TNFi (infliximab [IFX], etanercept [ETN], and adalimumab [ADA]).

Methods Data were retrospectively extracted from four local registries including all patients affected by PsA and ax-SpA treated with a biologic drug between January 2005 and May 2015. The analysis was limited to patients treated with IFX, ETN, or ADA as first-line biologic agent, with at least 1-year follow-up period. The 8-year drug survival was evaluated by Kaplan-Meier method and the risk for discontinuation among the 3 treatment groups was compared by a stratified log-rank test.

Results The study population (614 patients) included 316 ax-SpA (69.9% male, mean age [±SD] 42.8 [±12.1] years, mean disease duration 7.2 [±7.9] years), treated with ADA (n=95), ETN (n=42), or IFX (n=179); and 298 PsA (51.7% male, mean age 47.8 [±12.1] years, mean disease duration 8.8 [±7.7] years), treated with ADA (n=108), ETN (n=89), or IFX (n=101). The overall median survival on treatment of the whole study population was 117.17 months (102.84 and >117.17 months for axSpA and PsA, respectively; p=NS).

The overall retention rate was 66.2% (69.5% versus 62.8% in axSpA and PsA, respectively) at 5 years and 55.5% (57.2% versus 53.4% in axSpA and PsA, respectively) at 8 years. No significant differences emerged in the comparison among ADA, ETN, and IFX in both ax-SpA group (p=0.1065) and PsA group (p=0.06). IFX and ETN showed similar survival rates in PsA and axSpA (HR 1.252, 95% CI 0.600–2.608, and HR 1.224, 95% CI 0.8441–1.774, respectively), whereas ADA showed a significantly higher survival in axSpA compared to PsA (HR 1.775, 95% CI 1.045–3.013). Overall, 265 (43.1%) patients (129 [43.2%] PsA and 133 [42.1%] axSpA), stopped the first course TNFi. Inefficacy led to discontinuation in 115 (18.7%) patients (65 [21.8%] PsA and 50 [15.8%] axSpA), without significant differences between the two disease groups (p=0.1076). Adverse events led to discontinuation in 88 (14.3%) patients, (43 [14.4%] PsA and 45 [14.2%] axSpA), without significant differences between PsA and axSpA (p=0.9049).

Conclusions In a real-life setting, the 8-year retention rate of the first TNFi in the treatment of spondyloarthropathies was about 50%, with no significant difference between ax-SpA and PsA. The risk of stopping IFX and ETN treatment was similar in both ax-SpA and PsA group, whereas ADA showed a higher survival in axSpA group.

Disclosure of Interest None declared

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