FRI0382 TEN-YEAR RETENTION RATES OF FIRST-LINE BIOLOGICAL AGENT IN AXIAL SPONDYLARTHRITIS IN DAILY PRACTICE: A ROMANIAN MULTICENTRE EXPERIENCE
Authors: ANCUTA CODRINA, Cristina Pomirleanu, Raluca Paiu, Georgiana Strugariu, Luiza Petrariu, Eugen Ancuta, Codruta Bran, Rodica Chirieac, Claudia Mihailov
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Although the efficacy and long-term persistence of TNF inhibitors (TNF-i) are widely recognized in axial spondyloarthritis (axSpA), up to about one third of patients experience failure (loss of therapeutic response or toxicity) with the first biological agent requiring switching to another drug. <h3>Objectives</h3> The aims of our study were to assess the 10-year survival of the first TNF-i, to compare retention rates of different anti-TNF drugs in real life settings and to identify factors associated with drug retention in active axSpA. <h3>Methods</h3> We performed a hospital-based retrospective cohort study on consecutive adult axSpA suboptimally controlled by standard therapy, starting their first biological agent with infliximab (IFX), adalimumab (ADA), etanercept (ETA) or golimumab (GLM) according to local policy, recruited at three academic centres between 2003 and July 2018. Drug efficacy (BASDAI, ASDAS-CRP) as well as reasons for discontinuation were evaluated every 24 weeks. Drug survival was calculated using the Kaplan-Meier analysis, while univariate and multivariate regression was used for predictors of persistence and withdrawal (p&lt;0.05). Subanalysis was done according to discontinuation reasons. <h3>Results</h3> Of the 241 axSpa were recruited, 104 (43.15%) cases received ETA (original, biosimilar), 100 (41.49%) ADA, 26 (10.78%) IFX (original and biosimilar) and 11 cases (4.56%) GLM. Statistical significant improvement was demonstrated (ASDAS-CRP, BASDAI, BASFI) in all patients, those with higher disease activity and functional impairment at baseline presenting earlier and higher response rate (p&lt;0.05). We reported high long-term persistence of the first TNF-i with a median survival rate of 8.1±2.1 years for IFX, ADA and ETA; furthermore, at 10 years, up to one third (36%) of axSpA remained on the initial drug achieving either stable remission (62.24%) or low disease activity (37.76%), while one out of five patients on the same drug after 140 months. The retention rates of ETA, ADA and IFX were 70%, 68% and 57% after 3 years; 68%, 48% and 53% after 5 years; 35%, 30% and 27% after 10 years. Overall, retention to ETA was superior to that of monoclonal antibodies (p&lt;0.05), with a total drug-exposure of 625.43 patient-years for ETN, 415.26 for ADA, 221.53 for IFX. In addition, survival of the second TNF drug was good but inferior to the first TNF-I (p&lt;0.05). Male sex, age under 40, high baseline C reactive protein, low initial BASFI and disease duration under 5 years were associated with retention rate in multivariate analysis (p&lt;0.05), while the presence of syndesmophytes and obesity with higher withdrawal (p&lt;0.05). <h3>Conclusion</h3> We reported high long-term persistence of the first biological agent in axSpA, with superior retention for ETA compared to monoclonal antibodies. Predictors for high retention rate advocate the rationale for the drug choice in different axSpA settings. <h3>Disclosure of Interests</h3> CODRINA ANCUTA Speakers bureau: Abbvie, Pfizer, Novartis, MSD, Roche, Biogen, UCB, Lilly, Cristina Pomirleanu Speakers bureau: Abbvie, Pfizer, UCB, Raluca Paiu: None declared, Georgiana Strugariu Speakers bureau: Abbvie, Pfizer, UCB, Luiza Petrariu Speakers bureau: Abbvie, Pfizer, Novartis, Eugen Ancuta: None declared, Codruta Bran Speakers bureau: Abbvie, Pfizer, Novartis, Lilly, Roche, Rodica Chirieac: None declared, Claudia Mihailov Speakers bureau: Abbvie, Pfizer, Novartis, MSD, Roche, Biogen, UCB, Lilly