Session Information
Date: Tuesday, October 23, 2018
Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Treatment
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: To compare TNF inhibitor (TNFi) use and switching patterns among patients with nr-axSpA in the United States (US) and Europe (EU).
Methods: Data from a cross-sectional, multi-national survey of rheumatologists and their consulting axSpA patients conducted in France, Germany, Italy, Spain, United Kingdom, and the US were analyzed. Rheumatologists and patients completed forms containing information on current treatment and reasons for switching therapies.
Results: Data from 391 rheumatologists (299 EU/92 US) and 1,995 patients with nr-axSpA (1513 EU/482 US) were included in this analysis. In the US, 43.8% of patients were female, with a mean age of 42.6 years, while in the EU, 46.6% of patients were female, with a mean age of 41.0 years. In the US, 30.9% were in remission (as reported by their rheumatologist) compared to 41.3% patients in the EU. In the US sample, 57.7% of patients were receiving a TNFi, 35.1% were receiving a cDMARD and 46.3% were receiving a NSAID. In the EU sample, 54.1% were receiving a TNFi, 30.4% were receiving a cDMARD, and 48.3% were receiving a NSAID (Table 1).
US and EU patients that received TNFi (n=1079) had significantly higher physician-reported severity (p<0.0001) and higher levels of pain (p<0.0001) immediately prior to initiation of the current treatment regimen than those patients not receiving biologic therapy (n=916). Of the US patients prescribed a TNFi, 83.6% were receiving their first, 12.2% their second and 4.2% their third or more. Of the EU patients that were prescribed a TNFi, 91.1% were receiving their first, 6.9% their second, and 2.0% their third or more. Lack of remission, poor pain control, and worsening of condition were the main reasons that US patients switched to their current TNFi. Loss of response over time, worsening of condition, and lack of remission were the main reasons that EU patients switched to their current TNFi (Figure 1).
Conclusion: Even though over half of the patients in this survey were prescribed either a TNFi, cDMARDs, and/or NSAIDS, less than one-third of US patients and less than half of EU patients were in remission. While there was minimal switching of TNFi, when it was done, it was usually due to lack of efficacy, lack of pain relief, and inability to induce or maintain remission. New therapies such as IL-17 inhibitors were not included in this analysis. Additional research needs to be conducted to better understand how IL-17s can be utilized to help nr-axSpA patients achieve better outcomes.
Table 1. Medication use of nr-axSpA patients in the US and EU
|
EU (n=1,513) |
US (n=482) |
|
|
TNF inhibitors |
818 (54.1%) |
277 (57.4%) |
|
Adalimumab
|
321 (21.2%) |
116 (24.1%) |
|
Etanercept
|
208 (13.7%) |
90 (18.7%) |
|
Infliximab
|
107 (7.1%) |
48 (10.0%) |
|
Certolizumab Pegol
|
60 (4.0%) |
17 (3.5%) |
|
Golimumab
|
122 (8.1%) |
8 (1.7%) |
|
cDMARDs |
460 (30.4%) |
169 (35.1%) |
|
Methotrexate
|
284 (18.7%) |
90 (18.7%) |
|
Sulfasalazine
|
145 (9.6%) |
61(12.7%) |
|
Leflunomide
|
16 (1.1%) |
6 (1.3%) |
|
Hydroxychloroquine
|
4 (0.3%) |
7 (1.5%) |
|
Azathioprine
|
11(0.7%) |
5 (1.0%) |
|
NSAIDs |
731 (48.3%) |
223 (46.3%) |
|
Cox inhibitors |
167 (11.0%) |
21 (4.4%) |
|
Non-opioid analgesics |
150 (9.9%) |
12 (2.5%) |
|
Opioids |
50 (3.3%) |
23 (4.8%) |
|
Oral Steroids |
104 (6.9%) |
23 (4.8%) |
|
Injection Steroids |
17 (1.1%) |
12 (2.5%) |
Figure 1. Reasons that US and EU nr-axSpA patients switched to their current TNFi
To cite this abstract in AMA style:
Hunter T, Calderon DS, Lobosco S, Moon R, Milligan G, Bolce R. Comparing Treatment Patterns of Non-Radiographic Axial Spondyloarthritis Patients in the United States and Europe [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/comparing-treatment-patterns-of-non-radiographic-axial-spondyloarthritis-patients-in-the-united-states-and-europe/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparing-treatment-patterns-of-non-radiographic-axial-spondyloarthritis-patients-in-the-united-states-and-europe/