Background/Purpose: Anti-TNF-α agents are the mainstay of pharmacotherapy for patients with axial spondyloarthritis (AxSpA) who failed treatment with NSAIDs. A little is known about the influence of early versus delayed treatment initiation on their clinical efficacy.

Methods: Baseline demographic data and efficacy parameters of patients starting their first anti-TNF-α treatment ≤ 3 years (EARLY) or > 3 years (DEALYED) after diagnosis of AxSpA from the Czech national registry ATTRA were compared. ATTRA is a centralized prospective computerized registry of patients receiving bDMARD therapy for rheumatic diseases collecting data on efficacy, safety and quality of life of all patients treated in the Czech Republic. Anti-TNF-α therapy was indicated for patients with AxSpA who have failed treatment with NSAIDs with CRP ≥ 1mg/dl and BASDAI score ≥ 4.

Results: Data from 1899 axSpA patients were available for analysis. 689 patients started treatment ≤ 3 years and 1210 > 3 years after the diagnosis of AxSpA. There was no difference in gender distribution (72% males) or mean CRP level (2.5 mg/dl) at the time of treatment initiation between EARLY and DELAYED groups. Patients in the EARLY group were significantly younger (mean age 36.4 ± 10.4 vs 42.2 ± 10.9 years; P < 0.001) with shorter symptom duration (8.1 ± 7,4 vs 15.1 ± 9.0 years; P < 0.001). EARLY patients were less likely to be HLA B27 positive (87.9% vs 93.2%; P < 0.001). Disease activity was assessed using BASDAI at months 0, 3, 6, 12, 18 and 24. Activity was higher in the DELAYED group at all timepoints with statistically significant differences at baseline (6.4 ± 1.7 vs 6.2 ± 1.7; P = 0.003), 6 (2.5 ± 1.9 vs 2.3 ± 1.8; P = 0.038), 18 (2.3 ± 1.8 vs 1.9 ± 1.7; P = 0.001) and 24 months (2.3 ± 1.8 vs 2.0 ± 1.8; P = 0.049). There was no difference in survival on therapy between the groups with 85% patients remaining on the initial treatment at 1 year and 77% at 2 years. Radiographic progression was not assessed.

Conclusion: AxSpA patients starting anti-TNF-α therapy later than 3 years after diagnosis had slightly higher activity before and during treatment, however the differences were small and survival on therapy was not different compared to patients with earlier treatment initiation.

Acknowledgement: This study was supported by the project of MHCR for conceptual development of research organization 00023728

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparative-effectiveness-of-early-versus-delayed-anti-tnf-%ce%b1-treatment-in-axial-spondyloarthritis/