Background Extra-articular manifestations (EAMs), such as uveitis, inflammatory bowel diseases (IBD) and psoriasis (PsO), frequently complicate the disease course of patients with axial spondyloarthritis (axSpA), although prevalence data on this regard are still controversial. The occurrence of EAMs might also contribute to the decision of introducing a biologic therapy and even influence the choice between the available TNF inhibitors (TNFis).
Objectives The aim of this study is to retrospectively evaluate the prevalence of EAMs in a multicentre cohort of axSpA patients treated with TNFi, investigating how these influenced the choice of treatment.
Methods Clinical data from axSpA patients treated with a TNFi between May 2003 and May 2016 where obtained from a multicentre registry. Prevalence of EAMs (uveitis, IBD and PsO) was calculated at the time of TNFi prescription, evaluating their distribution according to drug subgroup.
Results The study included 503 patients with axSpA (172 [34.2%] women, mean age [±SD] 40.5 [±13.2] years, mean disease duration 9.7 [±14.7] years), receiving a total of 675 lines of treatment (I-line n=503, II-line n=118, ≥ III-line n=54) with a TNFi (272 infliximab [IFX], 173 adalimumab [ADA], 89 golimumab [GOL], 141 etanercept [ETN]). At the time of TNFi introduction, 28.6% patients claimed at least one EAM (IBD 11.3%, uveitis 10.9%, and PsO 8.8%). The baseline presence of at least one EAM was associated with a more frequent prescription of an anti-TNF monoclonal antibody rather than etanercept (34.1% versus 21.9%, respectively; p=0.005). In detail, EAMs were found in 41.6, 36.9, 29.8, and 21.9% patients treated with GOL, ADA, IFX, or ETN, respectively. The prevalence of IBD was significantly higher (p=0.004) in patients treated with ADA (12.7%), IFX (14.3%), or GOL (11.2%) compared with ETN (4.9%). Uveitis was numerically more frequent in GOL (20.2%) and ADA (13.3%) rather than IFX (9.5%) and ETN (9.9%) groups. Finally, PsO prevalence was similar in patients treated with ADA (10.9%) and GOL (10.1%), and numerically lower in the ETN (7.1%) and IFX (5.9%) groups.
Conclusions In our cohort of axSpA patients treated with TNFis, EAMs were highly represented. The presence of extra-articular involvement has been carefully taken into account when a TNFi was required to better control the disease. In particular, IBD and uveitis drove more frequently the choice toward an anti-TNF monoclonal antibody instead of the receptor.
Disclosure of Interest None declared