@article {Nikiphorouannrheumdis-2017-212457, author = {Elena Nikiphorou and D{\'e}sir{\'e}e van der Heijde and Sam Norton and Robert BM Landew{\'e} and Anna Molto and Maxime Dougados and Filip E Van den Bosch and Sofia Ramiro}, editor = {, and , and Allali, Fadoua and Gonz{\'a}lez, Raquel Almodovar and Blanco-morales, Elena Alonso and Alvarellos, Alejandro and Espinar, Maria Aparicio and Atagunduz, Pamir and Bakker, Pauline and Barreira, Juan C and Benbrahim, Leila and Benchekroun, Bahia and Berman, Alberto and Braun, Juergen and Cantagrel, Alain and Caporali, Roberto and Carvalho, Pedro and Casado, Gustavo and Wei, James Cheng-chung and Colombres, Francisco and Miguel mendieta, Eugenio Del and Diaz-garcia, Juan D and Bandt, Michel De and Duarte, Vanesa and Carballido, Cristina Fernandez and Fernandez espartero, Mari Cruz and Fernandez-prada, Manuel and Flipo, Rene-marc and Ugalde, Pilar Font and Gaudin, Philippe and Goupille, Philippe and C{\'a}novas, Dolors Grados and Masmitj{\'a}, Jordi Gratac{\'o}s and Grosso, Vittorio and Ichikawa, Naomi and Inoue, Hisashi and Kaneko, Yuko and Kawasaki, Taku and Kobayashi, Shigeto and Lahiri, Manjari and Maldonado-ficco, Hern{\'a}n and Marhadour, and Mart{\'\i}nez, Alejandro and Matsui, Kazuo and Esteban, Ram{\'o}n Mazzuchelli and Micelli, Corinne and Min, Chisun and Morita, Mitsuhiro and Mendoza, Juan Mulero and Noguera pons, Jose Raul and Okada, Masato and Ortiz, Alberto and Packham, Jon and Pend{\'o}n, Gisela and Pereira, Dora and Pereira da silva, Jos{\'e} A and Pimentel-santos, Fernando and Rkain, Hanan and Rillo, Oscar and Lozano, Carlos Rodriguez and Ruyssen-witrand, Adeline and Salas, Adri{\'a}n and Salinas-ramos, Carlos and Santosa, Amelia and Saraux, Alain and Sengupta, Raj and Siebert, Stefan and Soubrier, Martin and Spiegel, Caroline and Stolwijk, Carmen and Tada, Kurisu and Takizawa, Naoho and Taniguchi, Yoshinori and Taniguchi, Atsuo and Chou, Chung Tei and Teoh, Lay-keng and Tomita, Tetsuya and Tsai, Wen-chan and Tsuji, Shigeyoshi and Tsyplenkova, Olga and Tubergen, Astrid Van and Vakil-gilani, Kiana and Valle-o{\~n}ate, Rafael and Varkas, Gaelle and Villaverde, Virginia and Yap, Ai and Montejo, Pedro Zarco}, title = {Inequity in biological DMARD prescription for spondyloarthritis across the globe: results from the ASAS-COMOSPA study}, elocation-id = {annrheumdis-2017-212457}, year = {2017}, doi = {10.1136/annrheumdis-2017-212457}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objectives The value of biological disease-modifying antirheumatic drugs (bDMARDs) in spondyloarthritis (SpA) is well recognised, but global access to these treatments can be limited due to high costs and other factors. This study explores country variation in the use of bDMARDs in SpA in relation to country-level socioeconomic factors.Methods Patients fulfilling the Assessment in SpondyloArthritis International Society (ASAS) SpA criteria in the multinational, cross-sectional ASAS Comorbidities in Spondyloarthritis study were studied. Current use of bDMARDs or conventional synthetic DMARDs (csDMARDs) was investigated in separate models, with multilevel logistic regression analysis, taking the country level into account. Contribution of socioeconomic factors, including country health expenditures, gross domestic product and human development index as independent country-level factors, was explored individually, in models adjusted for sociodemographic as well as clinical variables.Results In total, 3370 patients from 22 countries were included (mean (SD) age 43 (14) years; 66\% male; 88\% axial disease). Across countries, 1275 (38\%) patients were bDMARD users. Crude mean bDMARD use varied between 5\% (China) to 74\% (Belgium). After adjustment for relevant sociodemographic and clinical variables, important variation in bDMARD use across countries remained (P\<0.001). Country-level socioeconomic factors, specifically higher health expenditures, were related to higher bDMARD uptake, though not meeting statistical significance (OR 1.96; 95\% CI 0.94 to 4.10). csDMARD uptake was significantly lower in countries with higher health expenditures (OR 0.32; 95\% CI 0.15 to 0.65). Similar trends were seen with the other socioeconomic variables.Conclusions There remains important residual variation across countries in bDMARD uptake of patients with SpA followed in specialised SpA centres. This is independent of well-known factors for bDMARD use such as clinical and country-level socioeconomic factors.}, issn = {0003-4967}, URL = {https://ard.bmj.com/content/early/2018/01/09/annrheumdis-2017-212457}, eprint = {https://ard.bmj.com/content/early/2018/01/09/annrheumdis-2017-212457.full.pdf}, journal = {Annals of the Rheumatic Diseases} }