Evaluation of the Adherence to Recommendations for Tnfα Blockers Use and Its Impact over 5 Years of Follow-up in Early Axial Spondyloarthritis. Data from the DESIR Cohort

Clementina López-Medina^1,2, Maxime Dougados³, Eduardo Collantes-Estévez⁴ and Anna Molto⁵, ¹Rheumatology Department, Reina Sofía University Hospital/ Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/ University of Cordoba, Cordoba, Spain, ²Rheumatology Department, Cochin Hospital, Paris, France, ³Hôpital Cochin, Paris, France, ⁴Rheumatology service, IMIBIC/Reina Sofia Hospital/University of Cordoba, Cordoba, Spain, ⁵Hôpital Cochin, Department of Rheumatology, Paris Descartes University, Paris, France

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Anti-TNF therapy and spondylarthritis

Session Information

Date: Monday, November 6, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Several recommendations have been published for the use of TNFα blockers (TNFb) in patients with axial Spondyloarthritis (axSpA). However, there is only sparse data on the adherence to these recommendations in daily clinical practice and the long-term impact of adhering to them. In this study, we aimed: a) to describe the adherence to the 2006 and 2016 ASAS/EULAR recommendations for TNFb initiation and continuation; b) to evaluate the impact of the adherence to these recommendations over 5 years of follow-up.

Methods: Data from the early axSpA patients from the DESIR cohort (first 5 years of follow-up) were analysed. We evaluated the adherence to 2006 and 2016 ASAS/EULAR recommendation for: a) TNFb initiation (patients were considered adherent if they initiated a TNFb when they met the conditions to do so according to recommendations or did not initiate a TNFb when conditions were not met) and; b) TNFb continuation (considering only those patients who initiated TNFb). Predictive factors and the impact of the adherence to these recommendations over 5 years were explored by multivariate logistic regression and mixed models with random effects, respectively.

Results: Out of the 708 patients included in the analysis, 440 (62.15%) and 389 (54.94%) were adherent to 2006 and 2016 recommendations for TNFb initiation, respectively. Patients adhering to 2006 recommendations for TNFb initiation were more frequently male [49.5% vs. 40.7%, OR 1.45 (95%CI 1.07-1.98)] and had more frequently a high level of education (university studies) [62.0%, vs. 53.7%, OR 1.43 (95%CI 1.05-1.95)] against patients not adhering. Patients adherent to 2006 and/or 2016 recommendations for TNFb initiation showed significantly lower levels in BASFI, SF-36 (mental and physical components) and in the number of days of sick leave over the 5 years of follow-up [10.7 ± 44.1 vs. 19.4 ± 58.4 days, p<0.001, in adherent vs. non-adherent patients for 2016 recommendations, respectively].

Among the 258 patients who initiated TNFb over follow-up, 232 (93.93%) continued the treatment. Among these, adherence to TNFb continuation recommendations was observed in 47.37% and 49.39% of patients, for 2006 and 2016 recommendations, respectively. Better outcomes over 5 years of follow-up were found in the group of patients adhering to recommendations for TNFb continuation (Table 1).

Conclusion: This study suggests that adherence to recommendations in the initiation and continuation of TNFb leads to better long-term outcomes in terms of quality of life and sick leave.

Table 1. Impact of the adherence to recommendations for TNFb continuation over 5 years of follow-up.
	2006 RECOMMENDATIONS FOR TNFb CONTINUATION			2016 RECOMMENDATIONS FOR TNFb CONTINUATION
	Adherence to 2006 rec. for continuation n = 117	No adherence to 2006 rec. for continuation n = 130	p-value¹	Adherence to 2016 rec. for continuation n=122	No adherence to 2016 rec. for continuation n = 125	p-value¹
BASFI over 5 years (0-100)	26.3 (22.1)	36.9 (22.7)	<0.001	27.1 (21.9)	36.6 (23.2)	<0.001
SF-36 mental component over 5 years (0-100)	42.0 (11.7)	39.6 (11.4)	0.002	42.1 (11.6)	39.4 (11.5)	0.010
SF-36 physical component over 5 years (0-100)	41.5 (9.3)	36.6 (8.6)	<0.001	41.1 (9.3)	36.8 (8.8)	<0.001
Sick leave over 5 years (days)	20.9 (57.7)	31.8 (76.5)	0.030	21.6 (59.7)	31.6 (75.7)	0.042

¹Mixed model for adherence vs. no adherence.

All results are presented as mean and Standard Deviation (SD)

Disclosure: C. López-Medina, None; M. Dougados, Abbvie, Pfizer, Eli Lilly and Company, Novartis, UCB, Merck, Roche, BMS UCB, 2,Abbvie, Pfizer, Eli Lilly and Company, Novartis, UCB, Merck, Roche, BMS, UCB, 5; E. Collantes-Estévez, None; A. Molto, None.

To cite this abstract in AMA style:

López-Medina C, Dougados M, Collantes-Estévez E, Molto A. Evaluation of the Adherence to Recommendations for Tnfα Blockers Use and Its Impact over 5 Years of Follow-up in Early Axial Spondyloarthritis. Data from the DESIR Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/evaluation-of-the-adherence-to-recommendations-for-tnf%ce%b1-blockers-use-and-its-impact-over-5-years-of-follow-up-in-early-axial-spondyloarthritis-data-from-the-desir-cohort/. Accessed .

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