Background/Purpose: Comprehensive guidelines for anti-TNFα were proposed in 2005 by the French Society for Rheumatology (SFR) in France; they did not include any economic considerations and they remained only informative for rheumatologists. Although they were not endorsed by the governmental agency, anti TNF-α were available without reimbursement restriction to all patients fulfilling them. Only limited information is available about patients who are potential candidates for anti-TNFα therapy (anti-TNFα) as well as about the physicians’ attitude towards initiation of anti‑TNFα.The French authorities initiated the CORPUS (cohorte d’observation rhumatologique des pratiques et des usages) survey to evaluate how rheumatologists prescribe anti TNF in active inflammatory rheumatic disease in case of the eligibility to biologics.

Methods: Between 2007 and 2009, 102 rheumatologists, internists and paediatricians in French University Hospitals and private practice recruited patients having an active IRD [DAS28 > 3.2 despite methotrexate use for rheumatoid arthritis (RA), BASDAI≥4 despite NSAID use for spondyloarthritis (SA) and not responder to methotrexate for Juvenile idiopathic arthritis (JIA)] naïve of biologics. They were followed prospectively for one year.

Results: Overall, 543 RA, 287 SA and 53 JIA patients were included among whom 382 RA, 171 SA and 28 JIA patients had complete follow-up data available at one year. The activity of the disease evaluated by the DAS, BASDAI and CHAQ was elevated in all goups. Both disability and quality of life indicators attested of the severity of the diseases. Among patients with available data, 110/382 (28.8%) RA, 81/171 (47.4%) SA, and 26/28 (92.9%) JIA patients received at least one injection of anti TNF-α during the first year of follow-up. Younger age, smoking, corticosteroid use, previous X-ray progression, higher disease activity (VAS patients, morning stiffness, DAS), higher disability (HAQ) level and poorer quality of life (SF36) at baseline were associated with anti TNF-α initiation among RA patients; by multivariate analysis, only younger age and poorer quality of life remained associated with anti TNF-α initiation. In SA patients, disease activity (high BASDAI), X-ray progression, high handicap (HAQ) level and poor quality of life (SF36) were also associated with anti TNF-α use. According to the physicians, the main reason for non prescription of anti- TNF-α to RA or AS patients was the low level of disease. In only 10% of cases, the lack of prescription was due to patient’s refusal and in 5% to contraindications.

Conclusion: In France, anti TNF-α, available without reimbursement restriction, was quite systematically prescribed to JIA patients not responder to methotrexate, to about one half of SA patients with BASDAI score ≥4, and to one third of RA patients with DAS28 score >3.2 despite methotrexate therapy.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/which-rheumatoid-arthritis-ankylosing-spondylitis-and-juvenile-idiopathic-arthritis-patients-initiate-anti-tnfa-therapy/