Background Tumour necrosis factor inhibitors (TNFi) have revolutionized treatment of axial spondylarthritis (axSpa). The five different available TNFi have not been compared directly, and whether effectiveness differs between agents is unknown. In Norway national authorities consider the different TNFi equivalent, and since 2009 the least expensive drug following an annual national tender has been the drug-of-choice in the publicly funded healthcare system. This has lead to variations across different years in drug use where choice of TNFi has been predominantly based on national price policy and not clinical characteristics.
Objectives Comparing response to TNFi during the first year of treatment of axSpA in biologics-naïve patients over years with highly varying uptake of different TNFi.
Methods We included the 981 biologics-naïve patients with axSpA from the NOR-DMARD register who started their first TNFi from 2009 through 2015. The preferred drugs in national recommendations were: 2009 adalimumab, 2010 golimumab, 2011 etanercept, 2012 etanercept, 2013 golimumab, 2014 certolizumab, 2015 certolizumab/biosimilar infliximab (CT-P13). We compared the estimated change in Ankylosing Spondylitis Disease Activity Score (ASDAS) between treatment years at 3, 6 and 12 months after treatment start using a mixed model with subject-specific random intercept, adjusting for baseline disease activity, age, sex and treatment centre.
Results Demographics, drug uptake and baseline characteristics for each year 2009–2015 are listed in table 1. The preferred drug was started in 57–91% of patients. There was a trend towards lower ASDAS and disease duration over time. There were no differences in treatment effectiveness between the years, regardless of the substantial differences in type of TNFi used (figure).
Conclusions Real-life data do not show differences in response to TNFi despite large annual variation in type of TNFi prescribed, indicating similar effectiveness of the available TNFi in patients with axSpA. This supports the practice of selecting drug based on cost and feasibility of use, as is the current practice in Norway. Further adoption of this principle can provide access to TNFi treatment to more patients, as it reduces costs and healthcare resources are limited.
Disclosure of Interest E. K. Kristianslund: None declared, K. M. Fagerli: None declared, E. Lie Consultant for: AbbVie, Celgene, Hospira, Pfizer, UCB., A. Wierød: None declared, S. Kalstad: None declared, E. Rødevand: None declared, F. Krøll: None declared, P. Mielnik: None declared, T. K. Kvien Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz, UCB, I. C. Olsen: None declared