Session Information
Date: Sunday, November 5, 2017
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The introduction of biological agents improved the prognosis of axial Spon-
dyloarthritis (axSpA). The Lund Efficacy Index (LUNDEX) allows evaluation of both survival and
efficacy of drugs. Our aims were to evaluate the long-term efficacy of biological disease modifying
drugs (b-DMARD) in axSpA using the LUNDEX, compare them and to determine the variables as-
sociated to the discontinuation of these treatments. Methods: Patients ≥ 18 years old who met
ASAS 2009 criteria for axSpA and who started b-DMARD for the first time between 01/2002 and
12/2016 were included. Sociodemographic variables, comorbidities, type of axSpA, disease dura-
tion and previous treatments were registered. Duration of therapy, causes of its suspension, effi-
cacy and safety were evaluated. BASDAI was assessed at baseline and during the treatment and
LUNDEX was calculated at 6 months and at 1 year of treatment using BASDAI cut-off <4 as effi-
cacy endpoint. Cumulative drug survival was assessed by Kaplan Meier curves and comparisons
using log Rank. Results: We included 101 patients. 80.2% were male, with a median age of 42
years (IQR 35-54.5), and median disease duration of 19.3 years (IQR 9.4-28.8). 26.7% of patients
didn´t have health insurance. 63.4% had pure axSpA, 13.8% Psoriatic Arthritis, 3% Reactive Ar-
thritis, 3% Inflammatory Bowel Disease and 16.8% Juvenile axSpA. The frequency of first b-
DMARD was: 44.6% Etanercept (ETA), 41.6% Adalimumab (ADA), 7.9% Infliximab and 5.9%
Certolizumab. 67.3% received b-DMARD monotherapy. BASDAI significantly improved over
time. The mean (X) cumulative survival time was 66.2 months (95%CI: 51.8-80.5). ADA survival
was longer than ETA one [ADA X 74.8 months (95%CI: 57.2-92.4) versus ETA X 53.2 (95%CI:
35.8-70.6) p = 0.02]. The causes of suspension were: lack of provision of the medication 41.1%, in-
efficacy 26.8%, adverse events 12.5% and other reasons 19.6%. Mean cumulative survival time
was lower for ETA vs ADA (53,18±8,8 vs 74,8 ±8,9, Log Rank=0.02), being the main cause the
lack of provision of the medication. In multivariate Cox regression analysis, after adjusting for
other factors, having private health insurance was the only factor that influenced on the survival of
the b-DMARD (HR 2.54, 95%CI 1.18-5.75). The global LUNDEX was 52.7% at 6 months and
46.9% at 12 months. The ADA LUNDEX was 50% at 6 months and 39.3% at 12 months, while
ETA LUNDEX was 60,2% at 6 months and 52% at 12 months. Conclusion: In our cohort of pa-
tients with axSpA, survival time of b-DMARD was clearly affected by socio-economic factors. Pa-
tients who can afford a private health insurance are more likely to persist with medication.
Disclosure: M. Cavalieri, None; E. E. Schneeberger, None; F. Dal Pra, None; R. Garcia Salinas, None; H. Maldonado Ficco, None; G. Citera, None.
To cite this abstract in AMA style:
Cavalieri M, Schneeberger EE, Dal Pra F, Garcia Salinas R, Maldonado Ficco H, Citera G. Long Term Survival of Biological Agents in Patients with Axial Spondyloarthritis. the Impact of Sociodemographic Factors in Latin-America [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/long-term-survival-of-biological-agents-in-patients-with-axial-spondyloarthritis-the-impact-of-sociodemographic-factors-in-latin-america/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-survival-of-biological-agents-in-patients-with-axial-spondyloarthritis-the-impact-of-sociodemographic-factors-in-latin-america/