Background/Purpose: The tumor necrosis factor α inhibitor (TNFi) therapy has been shown to be remarkably effective in ankylosing spondylitis (AS). However, almost 30% of AS patients stop TNFi or switch to another TNFi because of inefficacy or adverse effects, annually. The objective of our study was to assess the predictors of TNFi drug survival including extraarticular manifestions, using nationwide registry in Korea.

Methods: Data were obtained from the Korean College of Rheumatology BIOlogics (KOBIO) registry which is multi-center based national wide data from 53 tertiary care hospitals in Korea. Demographics, clinical features, laboratory findings, disease activity indices (BASDAI, ASDAS-ESR, ASDAS-CRP), and extraarticular manifestataions (uveitis, enthesitits, dactylitis, psoriasis, inflammatory bowel disease) were studied in patients with AS during the TNFi therapy. We analyzed the drug survival of 5 TNFi agents (etanercept, infliximab, infliximab biosimilar, adalimumab, and golimumab) and the factors affect drug survival especially in terms of extraarticular manifestations. To verify affecting factors, univariable and multivariable cox regression analysis were performed.

Results: Of 1482 AS patients starting TNFi drugs from Dec 2012 to Jan 2017 were included. In baseline, there was no difference of demographics, disease activity and extraarticular manifestations between continued and discontinued TNFi group except gender distribution, CRP, platelet counts, and HLA-B27 positivity. The effect of extraarticular manifestations including uveitis (unadjusted HR: 0.92, 95% CI 0.57 to 1.48 p value 0.74), enthesitits, dactylitis, psoriasis, and inflammatory bowel disease on TNFi drug survival was not statistically significant. But peripheral arthritis was statistically significantly associated with TNFi drug survival (unadjusted HR: 2.21 95% CI 1.66 to 2.95, adjusted HR 1.38 95% CI 1.01 to 1.88). Of disease activity indices, higher level of ASDAS-ESR showed statistical significance in TNFi drug survival (unadjusted HR: 1.87 95% CI 1.73 to 2.03, adjusted HR: 2.23 95% CI 2.00 to 2.63). Golimumab had higher retention rate to TNFi therapy than etanercept during 3 years of follow-up period (unadjusted HR: 0.46 95% CI 0.31 to 0.68, adjusted HR: 0.65 95% CI 0.43 to 0.99).

Conclusion: In national wide KOBIO registry, extraarticular manifestations including uveitis could not affect TNFi drug survival. But the development of peripheral arthritis during TNFi therapy had higher risk of discontinuance of its treatment in AS patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-extraarticular-manifestations-on-tumor-necrotic-factor-%ce%b1-inhibitor-drug-survival-in-patients-with-ankylosing-spondylitis-nationwide-data-from-the-korean-college-of-rheumatology-bio/