Background Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with axial spondyloarthritis (axSpA), but some patients switch to a different TNFi because of adverse effects (AE) or lack of effect (LOE). The EuroSpA Collaboration has previously demonstrated a 1-year retention rate of 79% and 6 months LUNDEX adjusted BASDAI<4 of 59%¹ in patients initiating the first TNFi treatment. Little is known about the effectiveness of switching to a second and third TNFi in patients with axSpA.

Objectives Firstly, to investigate retention and response rates at 6, 12 and 24 months in patients with axSpA initiating the 2^nd and 3^rd TNFi in clinical practice across Europe. Secondly, to investigate whether the outcomes were associated with the reason for withdrawal (AE or LOE) from the previous treatment.

Methods Prospectively collected data on axSpA patients in routine care from 12 European registries were pooled. Kaplan-Meier estimation was used to investigate TNFi retention rates. LUNDEX adjusted² response rates were calculated for BASDAI<4 and ASDAS inactive disease (ASDAS<1.3). Group comparisons were performed by Chi-square test.

Results A total of 7953 patients initiating their 2^nd TNFi and 2782 patients initiating 3^rd TNFi were included. Baseline characteristics are shown in the Table.

The overall retention rates for both 2^nd and 3^rd TNFi at 12 months were 72% (Figure). Corresponding retention rates for the individual registries ranged from 52-90% and 54-89%, respectively. In both patients who stopped 1^st TNFi due to AE or LOE, 12-month retention rate for the 2^nd TNFi treatment was 68%. In patients who stopped the 2^nd TNFi due to AE or LOE, 12-month retention rates for the 3^rd TNFi treatment were 68% and 69%, respectively.

For the 2^nd and 3^rd TNFi, 6 months LUNDEX adjusted BASDAI<4 were 44% and 37% (p<0.001), respectively, and for ASDAS inactive disease 18% and 13% (p=0.003) (Table).

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Conclusion Data from 12 European countries demonstrated decreasing response rates with increasing number of previous TNFi, although with only minor difference between 2^nd and 3rd. Patients who had withdrawn from the previous TNFi due to LOE had retention rates and remission rates similar to those who had withdrawn due to AE.

References [1] Brahe, et al. ACR2018

[2] Arthritis Rheum, 2006, 54(2), p:600-6.

Acknowledgement Novartis Pharma AG and IQVIA for supporting the EuroSpA collaboration

Disclosure of Interests Lykke Ørnbjerg Grant/research support from: Unrestricted grant: Novartis, Cecilie Heegaard Brahe Grant/research support from: Unrestricted grant: Novartis, Anne Gitte Loft: None declared, Johan Askling Grant/research support from: Karolinska Institutet (JA) has or has had research agreements with the following pharmaceutical companies, mainly in the context of the ATRIS national safety monitoring programme for rheumatology biologicals: Abbvie, BMS, MSD, Eli Lilly, Pfizer, Roche, Samsung Bioepis, and UCB., Consultant for: Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Lilly, Novartis, and Pfizer., Adrian Ciurea Consultant for: AbbVie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Heřman Mann Consultant for: Pfizer, Eli Lilly, Sanofi, Speakers bureau: AbbVie, Roche, Pfizer, MSD, Eli Lilly, Sanofi, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Eirik kristianslund: None declared, Dan Nordström Grant/research support from: MSD, Pfizer, Consultant for: AbbVie, BMS, MSD, Novartis, Roche, Pfizer, UCB, Speakers bureau: Novartis, UCB, Maria Jose Santos: None declared, Catalin Codreanu: None declared, Manuel Pombo-Suarez: None declared, Ziga Rotar: None declared, Björn Gudbjornsson: None declared, Daniela Di Giuseppe: None declared, Michael Nissen Consultant for: AbbVie, Lilly, Novartis, and Pfizer, Karel Pavelka: None declared, Soner Senel: None declared, Joe Sexton: None declared, Kari Eklund: None declared, Anabela Barcelos: None declared, Ruxandra Ionescu: None declared, Carlos Sánchez-Piedra: None declared, Matija Tomsic: None declared, Arni Jon Geirsson: None declared, Irene van der Horst-Bruinsma Grant/research support from: MSD, Pfizer, AbbVie, Consultant for: Abbvie, UCB, MSD, Novartis, Speakers bureau: BMS, AbbVie, Pfizer, MSD, Gary Macfarlane Grant/research support from: Have received research grants (not current) from Abbvie and Pfizer.

Have received research grants (not current) from the British Society for Rheumatology, who received the funds from Abbive, Pfizer and UCB.

Have received research grant (current) from the British Society for Rheumatology, who received the funds from Celgene., Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Brigitte Michelsen: None declared, Lise Hyldstrup: None declared, Niels Steen Krogh: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis, Mikkel Ǿstergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB