Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Treatment selection in Canadian routine clinical care is based on the judgment of the treating physician but is also affected by treatment guidelines and regional reimbursement which may vary over time. The objective of this analysis was to describe the regional and temporal variability of the profile of anti-TNF naïve patients with ankylosing spondylitis (AS) at initiation of adalimumab (ADA) following failure of initial non-biologic treatment.
COMPLETE-AS is an ongoing Canadian observational study of anti-TNFα naïve adults with active AS who require, per the judgment of the treating physician, change in current treatment. Patients are followed for up to 2 years. Regional variation between the following regions was assessed: Alberta/British Columbia/Manitoba (AB/BC/MB) vs. New Brunswick/Newfoundland/Nova Scotia (NB/NL/NS) vs. Ontario (ON) vs. Quebec (QC). In a sensitivity analysis, patients from AB and MB were excluded due to low numbers. Temporal variation over the following periods was assessed: 2011-2012 vs. 2013-2014 vs. 2015-2017. To evaluate the independent impact of region and time period on disease activity (BASDAI) and function (BASFI) multivariate linear regression was used.
A total of 459 patients were included of whom 95 (20.7%) were from AB/BC/MB, 39 (8.5%) from NB/NL/NS, 202 (44%) from ON and 123 (26.8%) from QC. By period, 133 (29%) were enrolled in 2011-2012, 133 (29%) in 2013-2014, and 193 (42%) in 2015-2017.
In univariate analysis, significant regional variation was observed in mean age (range from 41.1 to 48.4; p=0.013), gender (males from 46.3% to 64.2%; p=0.036), tobacco use (current smoking: 15.4% to 30.7%; p=0.003), alcohol use (non-drinker 17.9% to 52.6%; p=0.007), disease duration (4.2 to 9.7 years; p<0.001), and use of ADA monotherapy (71.6% to 87.2%; p=0.033). No differences in BASDAI and BASFI were observed. Similar results were observed in the sensitivity analysis. In terms of temporal variation, more recent years (2015-2017) were associated with lower BASDAI (6.4 vs. 6.7 vs. 6.2; p=0.040) and BASFI (5.6 vs. 5.9 vs. 5.1; p=0.013) scores without any other differences. In multivariate analysis adjusting for age and gender, enrollment period but not region was associated with BASDAI (p=0.034) and BASFI (p=0.006) levels, with patients in more recent years having less severe disease when initiating ADA.
Conclusion: The results of this analysis have shown that significant regional and temporal variation exists in the profile patients selected for ADA treatment in Canadian routine care. Furthermore, a significant independent association was identified between more recent years and lower BASDAI and BASFI scores at ADA initiation.
To cite this abstract in AMA style:Bessette L, Khraishi M, Pavlova V, Florica B, Remple VP. Regional and Temporal Variation in the Baseline Profile of Ankylosing Spondylitis Patients Initiating Adalimumab Following Failure of Non-Biologic Treatment in Canadian Routine Care [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/regional-and-temporal-variation-in-the-baseline-profile-of-ankylosing-spondylitis-patients-initiating-adalimumab-following-failure-of-non-biologic-treatment-in-canadian-routine-care/. Accessed October 21, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/regional-and-temporal-variation-in-the-baseline-profile-of-ankylosing-spondylitis-patients-initiating-adalimumab-following-failure-of-non-biologic-treatment-in-canadian-routine-care/