THU0391 COMPARISON OF CHARACTERISTICS AND BURDEN OF DISEASE IN PATIENTS WITH RADIOGRAPHIC AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
Authors: Clementina López-Medina, Sofia Ramiro, Désirée van der Heijde, Maxime Dougados, Anna Moltó
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In 2009, the ASAS criteria allowed to classify patients with radiographic (r-axSpA) and non-radiographic (nr-axSpA) axial Spondyloarthritis (axSpA), and enhanced the concept of axSpA as a whole disease with different phenotypic presentations. However, some have claimed that the burden of r-axSpA and nr-axSpA is so different that they should be considered as different forms of the same disease. <h3>Objectives</h3> To compare the characteristics, burden of disease and treatment effect in patients with r-axSpA and nr-axSpA. <h3>Methods</h3> A systematic literature review until October 2018 was performed using PubMed, EMBASE and Cochrane databases. The PICO approach was used to formulate the research questions: P (r-axSpA patients), I (no intervention/drugs (only for the treatment effect evaluation), C (nr-axSpA patients), O (clinical presentation, disease activity, structural damage, function, quality of life, mobility, treatment modalities and treatment effect). Only observational studies and Randomized Controlled Trials (RCT) published after 2009 (year of publication of the ASAS criteria) were included. For the evaluation of the treatment effect, only RCT were considered. Risk of bias was evaluated on each manuscript with the Cochrane Risk of Bias tool for RCT and Hayden tool for observational studies. Pooled analysis was performed (Standardized Means Differences (SMD) and Relative Risk (RR) for continuous and binary variables, respectively) with a random effects model after evaluation of the heterogeneity of the studies. <h3>Results</h3> A total of 60 studies out of 787 references were included. Clinical presentation, disease activity, burden of disease (function, quality of life and mobility), treatment and treatment effect were evaluated in 54 (90.0%), 40 (67.7%), 37 (61.7%), 18 (30.0%) and in 9 (15.0%) manuscripts, respectively. Only 3 cross-sectional studies were classified as high risk of bias. Pooled results concerning continuous and binary variables are represented in tables 1 and 2. Only two RCTs (Etanercept vs. Sulfasalzine and Certolizumab vs. Placebo) directly compared the treatment effect between both groups, and none of them showed differences regarding ASAS partial remission, ASDAS major improvement and ASAS 40. <h3>Conclusion</h3> Published data suggest that r-axSpA and nr-axSpA patients share a similar clinical presentation except for peripheral manifestations (which are more prevalent among nr-axSpA), males and smokers (which are more frequent among r-axSpa). Disease activity and burden of disease are identical in both groups, except mobility, which is poorer among r-axSpA. The treatment effect was similar in both groups. <h3>Disclosure of Interests</h3> Clementina López-Medina: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Désirée van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Union Chimique Belge, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Anna Moltó: None declared