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SAT0392 The Drug Survival of Anti-Tumour Necrosis Factor (TNF) Treatment in A UK Cohort of Axial Spondyloarthritis Patients
  1. F. Yahya1,2,
  2. C. Cavill1,
  3. J. Berry-Jenkins1,
  4. D. Bond1,
  5. C. Boyle1,
  6. R. Sengupta1,3
  1. 1Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom
  2. 2Department of Medicine, University Malaya, Kuala Lumpur, Malaysia
  3. 3University of Bath, Bath, United Kingdom

Abstract

Background The use of anti-Tumour Necrosis Factor (TNF) therapy has made a huge impact in the treatment of axial spondyloarthritis (axSpA) patients which include ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Patients typically commence these drugs if they fulfil criteria set out by the National Institute for Health Care and Excellence (NICE) guidelines1. Continuation of anti-TNF therapy depends on their response, or the occurrence of adverse events (AEs). Current NICE guidelines allow switching to an alternative anti-TNF if side effects occur early in the treatment course. However, few studies have provided data regarding the patterns of drug survival and reasons for discontinuation of anti-TNF in a UK cohort of AxSpA patients2.

Objectives To analyse the long-term survival of anti-TNF in AS patients and the reasons for switching anti-TNF therapy in a UK cohort.

Methods We conducted a retrospective analysis of patients who fulfilled AS or nr-axSpA ASAS Classification criteria3, aged 18 years or above, who received at least one anti-TNF agent at the Royal National Hospital for Rheumatic Diseases (RNHRD) Bath. Data were collected from review of the patients' medical notes. Data included the types and duration of anti-TNF used, and the reasons anti-TNF therapy needed to be stopped or changed. The initial anti-TNF agent prescribed is described as the index treatment.

Results 305 patients,with a mean age of 49.7 (SD12.81), were recruited from the RNHRD AxSpA Biologics database. 261 patients were included in the final data analysis with 90.8% fulfilling the modified New York criteria. Female n=63 (24.1%). The index anti-TNF treatment were Adalimumab n=123 (47.1%), Etanercept n=84 (32.2%), Golimumab n=27 (10.3%), Certolizumab pegol n=15 (5.7%), and Infliximab n=12 (4.6%). 110 (40.4%) patients had to discontinue their index treatment. The most frequent reasons for discontinuation of index anti-TNF included AEs n=36 (36.4%) and loss or lack of efficacy (LOE) n=34 (34.3%). In patients who proceeded to switch to a 2nd anti-TNF, the main reason for stopping the index anti-TNF was AEs n=18 (40%). 26 (57.8%) patients stopped their 2nd anti-TNF treatment with LOE n=12 (46.1%) as the main reason. 6 (23.1%) patients proceeded to have a 3rd anti-TNF with 3 (50%) patients had to stop this completely.

Conclusions About half of the patients had to discontinue their anti-TNF treatment either as an index treatment or subsequent treatment. The most common reason for stopping anti-TNF treatment in our cohort was due to adverse events. 45.5% of patients switched to a second anti-TNF agent and 23.1% of the patients switched from a second to a third anti-TNF agent.

  1. NICE Technology Appraisal Guidance (TA143): Adalimumab, Etanercept and infliximab for ankylosing spondylitis. 2008.

  2. Rosales-Alexander JL, Aznar JB, Pérez-Vicente S, et al.Drug survival of anti-tumour necrosis factor α therapy in spondyloarthropathies: results from the Spanish emAR II Study. Rheumatology 2015; 54 (8):1459–1463.

  3. Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis 2009; 68: 777–783.

Disclosure of Interest None declared

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