The effect of comedication with conventional synthetic disease modifying antirheumatic drugs on TNF inhibitor drug survival in patients with ankylosing spondylitis and undifferentiated spondyloarthritis: results from a nationwide prospective study

Abstract

Objective To assess the effect of comedication with conventional synthetic disease modifying antirheumatic drugs (csDMARDs) on retention to tumour necrosis factor inhibitor (TNFi) therapy in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA). Methods Data on patients with a clinical diagnosis of AS or uSpA starting treatment with adalimumab, etanercept or infliximab as their first TNFi during 2003-2010 were retrieved from the Swedish national biologics register and linked to national population based registers. Five-year drug survival was analysed by Cox regression with age, sex, baseline csDMARD comedication, TNFi type, prescription year and covariates representing frailty and socioeconomic status. AS and uSpA were analysed separately. Sensitivity analyses included models with csDMARD as a time-dependent covariate and adjustments for additional potential confounders. Results 1365 patients with AS and 1155 patients with uSpA were included, of whom 40.8% versus 50.3% used csDMARD comedication at baseline. In the unadjusted analyses superior drug survival was observed for patients using versus not using csDMARD comedication among patients with AS (p<0.001) but not among patients with uSpA (p=0.175). In the multivariable Cox regression analyses comedication with csDMARD was associated with better retention to TNFi therapy both in AS (HR 0.71, p<0.001) and uSpA (HR 0.82, p=0.020). The results were similar with csDMARD comedication as a time-dependent covariate, and the associations were retained when adjusting for erythrocyte sedimentation rate, C-reactive protein, patient global, swollen joints, uveitis, psoriasis and inflammatory bowel disease. Conclusions In this large register study of patients with AS and uSpA, use of csDMARD comedication was associated with better 5-year retention to the first TNFi.

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

“…This was verified in unadjusted models and adjusted for baseline covariates Cox-extended models (data not shown). Accordingly, Lie, et al showed a higher retention rate in AS compared to uSpA 10 , similar to our data. However, in other studies of significantly shorter followup, a comparable TNFi drug survival was found between patients with PsA and AS 8,9,13 .…”

“…Along with other studies 5 , we found no protective effect of MTX co-medication in AS; this finding is supported by smaller studies 17,18 . On the contrary, investigators from the Antirheumatic Therapies In Sweden registry reported a positive effect of MTX 10 . Although not strongly supported by the evidence thus far and not proposed for the treatment of axial disease by ASAS/EULAR recommendations 19 , a favorable effect of MTX, especially for those with peripheral arthritis, cannot be excluded.…”

“…Moreover, patients were recruited based on the diagnosis of expert treating rheumatologists and not on classification criteria. This could be considered an inherent limitation of most registries, wherein, comparable to our study, patients are included based on treating rheumatologists' diagnoses 10,15,27,28 . Nevertheless, we have to note that most of our patients had established, longstanding diseases; they were all followed by experienced rheumatologists, and baseline demographics and disease characteristics are well in accordance with available epidemiologic data and those reported by other registries 14,29,30 .…”

“…However, most of these studies have focused on individual clinical subtypes within the spectrum of SpA, mainly ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Only a limited number of studies, mainly in the early years of TNFi use and with short-term followup, analyzed patients with SpA as a whole group and compared data between subdiagnoses 8,9,10 .…”

Investigation of a Role of the Immunogenicity of Infliximab in the Therapy of Ankylosing Spondylitis

“…Использование MT снижа-ет, но не предотвращает образование АТ к препарату [12]. Однако пациенты с АС, которые получали базис-ные противовоспалительные препараты (БПВП) с пер-вым ингибитором ФНОα, оставались на этой терапии достоверно дольше, чем те, кто не получал БПВП [22]. В нашей группе не было пациентов, получающих ИНФ в сочетании с МТ.…”