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
Patients with ankylosing spondylitis had better adalimumab survival than patients with non-radiographic axial spondyloarthritis
Background/Purpose: Drug survival rate is generally accepted as a reliable indicator of both efficacy and safety profile of a biological DMARD. We aimed to evaluate survival rates of adalimumab (ADA) in ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA) patients registered in HUR-BIO (Hacettepe University Rheumatology Biologic Registry) and potential predictors of drug continuation.
Methods: HUR-BIO is a monocentric database of biologics including 1938 SpA patients by January 2017. All AS and nrAxSpA patients in HUR-BIO prescribed ADA at least once were enrolled in the study. Patients who were prescribed ADA within 6 months period before analysis defined as drug continuing. Reasons for ADA discontinuation were categorized as adverse events (AEs), inefficacy (primary and secondary) and others. Kaplan-Meier analysis was used to estimate ADA survival rates. Potential predictors of ADA continuation were evaluated using Cox proportional regression model in only AS patients due to small number of patients in nrAxSpA group.
Results: In total, 421 AS and 103 nrAxSpA patients were analyzed. Median duration of ADA usage was 14.5 (0-139.2) months in AS and 8.7 (0-84.2) months in nrAxSpA group. Baseline characteristics of patients were shown in Table 1. Among AS patients, ADA was discontinued due to inefficacy in 70 (30.4%) and adverse events in 39 (17.0%). The reason for ADA discontinuation was inefficacy in 28 (48.3%) and adverse events in 5 (8.6%) nrAxSpA patients. Figure 1 represents the Kaplan-Meier plots of ADA survival. Log-rank between AS and nrAxSpA patients was found as p=0.044. Cox proportional regression model failed to demonstrate any predictor of ADA discontinuation in AS patients.
Conclusion: In this single center biological SpA cohort, ADA had better drug survival in AS patients compared with nrAxSpA consistent with literature1. Although certain factors such as uveitis, baseline increased acute phase reactants, and being biological naïve were associated with better ADA survival in univariate analysis, we could not demonstrate any predictors in Cox regression analysis.
References
1. Wallman JK et al. Arthritis Res Ther. 2015 24;17:378.
Table 1. Baseline characteristics of AS and nrAxSpA patients
|
|
AS |
nrAxSpA |
|||||
|
|
Continue (n=191) |
Discontinue (n=230) |
P |
Continue (n=44) |
Discontinue (n=59) |
P |
|
|
Age,years (min-max) |
38.4 (18.0-65.9) |
38.0 (12.0-65.9) |
0.27 |
34.1 (17.1-63.4) |
34.5 (17.0-51.3) |
0.79 |
|
|
|
Male,n (%) |
118 (61.8) |
121 (52.6) |
0.06 |
22 (50.0) |
18 (30.5) |
0.04 |
|
|
Female,n (%) |
73 (38.2) |
109 (47.4) |
22 (50.0) |
41 (69.5) |
||
|
Disease duration, months (min-max) |
55.4 (1.2-475.6) |
56.8 (1.5-431.8) |
0.55 |
18.2 (1.6-104.8) |
24.0 (1.3-182.9) |
0.27 |
|
|
Disease duration ≥5 years,n (%) |
68 (35.6) |
61 (26.5) |
0.13 |
10 (22.7) |
8 (13.5) |
0.15 |
|
|
History of smoking ,n (%) |
115 (60.2) |
113 (49.1) |
0.13 |
22 (50.0) |
31 (52.5) |
0.79 |
|
|
History of uveitis,n (%) |
34 (17.8) |
22 (9.6) |
0.03 |
4 (9.0) |
7 (11.9) |
0.65 |
|
|
Previous biologic use, n (%) |
35 (18.3) |
75 (76.1) |
0.001 |
10 (22.7) |
12 (20.3) |
0.77 |
|
|
Baseline BASDAI |
53 (0-94) |
53 (0-94) |
0.21 |
55 (8-91) |
55 (9-92) |
0.92 |
|
|
Baseline BASFI |
38 (0-98) |
46 (0-99) |
0.09 |
45 (2-85) |
45 (1-96) |
0.87 |
|
|
Baseline back pain VAS |
60 (0-100) |
60 (5-100) |
0.29 |
70 (0-90) |
70 (1-90) |
0.35 |
|
|
ESR,mm/h (min-max) |
23 (2-120) |
18 (0-120) |
0.002 |
10 (2-69) |
10 (2-97) |
0.64 |
|
|
CRP,mg/dL (min-max) |
1.37 (0.1-26.7) |
1.20 (0.1-28.0) |
0.013 |
0.52 (0.1-6.4) |
0.60 (0.1-10.6) |
0.95 |
|
|
ESR > UL, n (%) |
98 (51.3) |
93 (40.4) |
0.04 |
13 (29.5) |
16 (27.1) |
0.85 |
|
|
CRP > UL, n (%) |
118 (61.8) |
134 (58.3) |
0.58 |
14 (31.8) |
23 (39.0) |
0.44 |
|
|
Syndesmophits on X-ray,n (%) |
56 (46.3) |
65 (53.7) |
0.06 |
|
|
|
|
Figure 1. ADA survival rates in AS and nrAxSpA patients
To cite this abstract in AMA style:
Sari A, Armagan B, Erden A, Kilic L, Karadag O, Akdogan A, Kalyoncu U, Ertenli I. Patients with Ankylosing Spondylitis Had Better Adalimumab Survival Than Patients with Non-Radiographic Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/patients-with-ankylosing-spondylitis-had-better-adalimumab-survival-than-patients-with-non-radiographic-axial-spondyloarthritis/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-with-ankylosing-spondylitis-had-better-adalimumab-survival-than-patients-with-non-radiographic-axial-spondyloarthritis/