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Different drug survival of first line tumour necrosis factor inhibitors in radiographic and non-radiographic axial spondyloarthritis: a multicentre retrospective survey.
Clin Exp Rheumatol. 2019 Sep-Oct; 37(5):762-767.CE

Abstract

OBJECTIVES

Good drug survival of tumour necrosis factor inhibitors (TNFi) has been shown in axial spondyloarthritis (axSpA) patients treated in real-life setting. However, few studies have compared drug survival of the first TNF inhibitor between radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) patients in real-world clinical practice. The aim of this work was to evaluate the effectiveness by assessing the retention rate of first-line TNFi in r-axSpA and nr-axSpA patients. Baseline predictive factors for TNFi discontinuation were also evaluated.

METHODS

We retrospectively assessed axSpA patients, who underwent first line therapy with TNFi. Demographic and clinical data was obtained through structured interview, review of medical records and physical examination. Disease activity indices such as the Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score evaluating C Reactive Protein (ASDAS-CRP), Leeds Enthesitis Index (LEI) were assessed at baseline. Moreover Health Assessment QuestionnaireDisability Index (HAQ), erythrocyte sedimentation rate (ESR, mm/h), CRP (mg/dl) and HLA-B27 were recorded as well. Data on x-ray and magnetic resonance imaging of the sacroiliac joints were also collected. Drug retention rates were analysed using Kaplan-Meier curves; log-rank test was performed to demonstrate differences in the survival functions. Cox regression models were used to estimate the inference of several disease and clinical characteristics on drug discontinuation.

RESULTS

Drug survival of first-line TNFi was significantly lower in patients who had nr-axSpA than in those with r-axSpA (p=0.005). HLA-B27 frequency was higher in patients with x-ray sacroiliitis than in those with nr-axSpA (p=0.01) as well as mean CRP serum level (p=0.0001), whereas both mean BASDAI and LEI score were higher in patients with nr-axSpA than in those with r-axSpA (p=0.018 and p=0.007, respectively). Global retention rate in our cohort was 60.34% with mean survival time (MST) of 58.68 months (95% CI 47.93-69.42). MST for patients diagnosed with r-axSpA was 66.79 months (95% CI 53.54-80.04) and 39.05 months (95% CI 24.12-53.99) for those with nr-axSpA. Moreover, nr-axSpA (HR 1.620), higher BMI (HR 1.093) and BASFI, (HR 1.192) had an impact on drug discontinuation, whereas HLA-B27 presence (HR. 0.523) had protective effect.

CONCLUSIONS

Effectiveness of TNFi, seems to be lower in nr-axSpA patients than in those with r-axSpA. In addition obesity and functional disability negatively impact the persistence on first line TNFi in axSpA patients in real life setting.

Authors+Show Affiliations

Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Italy. glopalco@hotmail.it.Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Italy.Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.Department of Experimental and Clinical Medicine, University of Florence, Italy.Rheumatological Clinic, Ospedale 'Carlo Urbani', Università Politecnica delle Marche, Jesi, Ancona, Italy.Rheumatological Clinic, Ospedale 'Carlo Urbani', Università Politecnica delle Marche, Jesi, Ancona, Italy.Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy.Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.Department of Experimental and Clinical Medicine, University of Florence, Italy.Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Italy.Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Italy.Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy.Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Italy.Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Italy.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31025925

Citation

Lopalco, Giuseppe, et al. "Different Drug Survival of First Line Tumour Necrosis Factor Inhibitors in Radiographic and Non-radiographic Axial Spondyloarthritis: a Multicentre Retrospective Survey." Clinical and Experimental Rheumatology, vol. 37, no. 5, 2019, pp. 762-767.
Lopalco G, Venerito V, Cantarini L, et al. Different drug survival of first line tumour necrosis factor inhibitors in radiographic and non-radiographic axial spondyloarthritis: a multicentre retrospective survey. Clin Exp Rheumatol. 2019;37(5):762-767.
Lopalco, G., Venerito, V., Cantarini, L., Emmi, G., Salaffi, F., Di Carlo, M., Tafuri, S., Gentileschi, S., Di Scala, G., Nivuori, M., Cacciapaglia, F., Galeazzi, M., Lapadula, G., & Iannone, F. (2019). Different drug survival of first line tumour necrosis factor inhibitors in radiographic and non-radiographic axial spondyloarthritis: a multicentre retrospective survey. Clinical and Experimental Rheumatology, 37(5), 762-767.
Lopalco G, et al. Different Drug Survival of First Line Tumour Necrosis Factor Inhibitors in Radiographic and Non-radiographic Axial Spondyloarthritis: a Multicentre Retrospective Survey. Clin Exp Rheumatol. 2019;37(5):762-767. PubMed PMID: 31025925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Different drug survival of first line tumour necrosis factor inhibitors in radiographic and non-radiographic axial spondyloarthritis: a multicentre retrospective survey. AU - Lopalco,Giuseppe, AU - Venerito,Vincenzo, AU - Cantarini,Luca, AU - Emmi,Giacomo, AU - Salaffi,Fausto, AU - Di Carlo,Marco, AU - Tafuri,Silvio, AU - Gentileschi,Stefano, AU - Di Scala,Gerardo, AU - Nivuori,Mariangela, AU - Cacciapaglia,Fabio, AU - Galeazzi,Mauro, AU - Lapadula,Giovanni, AU - Iannone,Florenzo, Y1 - 2019/04/16/ PY - 2018/08/04/received PY - 2018/11/12/accepted PY - 2019/4/27/pubmed PY - 2019/10/9/medline PY - 2019/4/27/entrez SP - 762 EP - 767 JF - Clinical and experimental rheumatology JO - Clin. Exp. Rheumatol. VL - 37 IS - 5 N2 - OBJECTIVES: Good drug survival of tumour necrosis factor inhibitors (TNFi) has been shown in axial spondyloarthritis (axSpA) patients treated in real-life setting. However, few studies have compared drug survival of the first TNF inhibitor between radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) patients in real-world clinical practice. The aim of this work was to evaluate the effectiveness by assessing the retention rate of first-line TNFi in r-axSpA and nr-axSpA patients. Baseline predictive factors for TNFi discontinuation were also evaluated. METHODS: We retrospectively assessed axSpA patients, who underwent first line therapy with TNFi. Demographic and clinical data was obtained through structured interview, review of medical records and physical examination. Disease activity indices such as the Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score evaluating C Reactive Protein (ASDAS-CRP), Leeds Enthesitis Index (LEI) were assessed at baseline. Moreover Health Assessment QuestionnaireDisability Index (HAQ), erythrocyte sedimentation rate (ESR, mm/h), CRP (mg/dl) and HLA-B27 were recorded as well. Data on x-ray and magnetic resonance imaging of the sacroiliac joints were also collected. Drug retention rates were analysed using Kaplan-Meier curves; log-rank test was performed to demonstrate differences in the survival functions. Cox regression models were used to estimate the inference of several disease and clinical characteristics on drug discontinuation. RESULTS: Drug survival of first-line TNFi was significantly lower in patients who had nr-axSpA than in those with r-axSpA (p=0.005). HLA-B27 frequency was higher in patients with x-ray sacroiliitis than in those with nr-axSpA (p=0.01) as well as mean CRP serum level (p=0.0001), whereas both mean BASDAI and LEI score were higher in patients with nr-axSpA than in those with r-axSpA (p=0.018 and p=0.007, respectively). Global retention rate in our cohort was 60.34% with mean survival time (MST) of 58.68 months (95% CI 47.93-69.42). MST for patients diagnosed with r-axSpA was 66.79 months (95% CI 53.54-80.04) and 39.05 months (95% CI 24.12-53.99) for those with nr-axSpA. Moreover, nr-axSpA (HR 1.620), higher BMI (HR 1.093) and BASFI, (HR 1.192) had an impact on drug discontinuation, whereas HLA-B27 presence (HR. 0.523) had protective effect. CONCLUSIONS: Effectiveness of TNFi, seems to be lower in nr-axSpA patients than in those with r-axSpA. In addition obesity and functional disability negatively impact the persistence on first line TNFi in axSpA patients in real life setting. SN - 0392-856X UR - https://www.unboundmedicine.com/medline/citation/31025925/Different_drug_survival_of_first_line_tumour_necrosis_factor_inhibitors_in_radiographic_and_non_radiographic_axial_spondyloarthritis:_a_multicentre_retrospective_survey_ L2 - https://www.clinexprheumatol.org/pubmed/find-pii.asp?pii=31025925 DB - PRIME DP - Unbound Medicine ER -