BackgroundPain, fatigue and altered quality of life are frequent complaints in axial spondyloarthritis (axSpA), with an impact on disease activity evaluation, regardless of radiographic or non-radiographic phenotype.No study compares face to face the effects of biologic DMARDs (bDMARDs) on patient reported outcomes (PROs).ObjectivesTo evaluate the impact of biologic DMARDs (bDMARDs: anti-TNF and anti-IL17) on three PROs (pain, fatigue, quality of life) in patients with axial spondyloarthritis (axSpA).MethodsA systematic review was performed in PubMed, Embase until May 2022, and abstracts from EULAR and ACR meetings for the past 3 years. The search included all randomized controlled trials of bDMARDS with outcomes reporting data on pain (“total back pain”, “nocturnal back pain”), fatigue (FACIT-F) and quality of life (ASQoL and SF36 PCS and MCS) in patients with axSpA.Statistical analysis used the inverse variance method to obtain results as mean differences, which were visualized by forest plot. Variation between studies was assessed by calculating the heterogeneity (I²) with Cochran’s Q test.ResultsA total of 25 studies were included in the final analysis, with a total number of 8457 patients.Compared to placebo, treatment with bDMARDs was associated with a significant improvement in pain, fatigue and quality of life. The mean differences were -1.47 (95% CI (-1.72, -1.22)) for total back pain, -1.67 (95% CI (-2.06, -1.28)) for nocturnal back pain, 4.47 (95% CI (3.23, 5. 72)) for FACIT-F, -2.59 (95% CI (-2.68, -2.49)) for ASQoL, 3.68 (95% CI (3.21, 4.15)) for SF36 PCS and 2.79 (95% CI (1.83, 3.75)) for SF36 MCS.For the subgroup analysis comparing the different bDMARDs, the effects on pain were numerically superior with anti-TNF, but the difference was not significant because of the confidence intervals overlapping. There was no difference for the other PROs between anti-TNF and anti-IL17. Heterogeneity was weak except for the “nocturnal back pain” scale.For the subgroup analysis comparing axSpA phenotypes, the improvement of PROs on bDMARDs between radiographic and non-radiographic axSpA was not different, except for the mental component of the SF36 score less improved in the non-radiographic axSpA.ConclusionbDMARDs (anti-TNF and anti-IL17) significantly improve pain, fatigue and quality of life compared to placebo in patients with axSpA. No significant difference was observed between anti-TNF and anti-IL-17, nor between radiographic and non-radiographic axSpA, except for the mental component of the SF36.References: NilAcknowledgementsTo Thomas Barnetche for statistical analysis.Disclosure of InterestsEmma Gadon: None declared, Thibaud Loupret: None declared, Camille Lemaçon: None declared, Philippe Bertin Speakers bureau: Pfizer, Abbvie, UCB, Lilly, Novartis, Pascale Vergne-Salle Speakers bureau: Pfizer, Abbvie, UCB, Lilly, Novartis.
