SAT0297 The role of baseline concomitant use of conventional synthetic disease modifying anti-rheumatic drugs with tnf inhibitors in spondyloarthritis patients
Authors: S. Akar, S. Kiraz, O. Gercik, I. Ertenli, O. Kucuksahin, E. Dalkilic, C. Bes, T. Kasifoglu, H. Emmungil, S.S. Koca, M. Cinar, V. Yazisiz, B. Kelesoglu Dincer, A. Ates, N. Alpay Kanitez, S. Erten, S. Turan, Y. Pehlivan, B. Oz, S. Yasar Bilge, A. Erden, B. Armagan, B.N. Coşkun, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are drugs of choice in the treatment of rheumatoid arthritis and their concomitant use with TNFi is also of unequivocal importance. On the other hand there is limited evidence regarding the efficacy of csDMARD in axial spondyloarthritis (SpA) and concomitant use with TNFi are not recommended. However recently there is conflicting results about the comedication with csDMARD on the TNFi drug survival in patients with AS. <h3>Objectives</h3> To evaluate the effect of concomitant csDMARD use on first TNFi drug survival in patients with spondyloarthritis. <h3>Methods</h3> The data of patients that have been included in two Turkish registries (TURKBIO (n=356) and TReasure (n=1382)) with the diagnosis of ankylosing spondylitis (AS) or SpA obtained. Drug survival was calculated from the date of first TNFi prescription to the last visit or until the stop date of first biologic agent. For drug survival analysis Kaplan-Meier method with log-rank test. Cox proportional hazard method was used to evaluate the relative effects of each covariate on the drug survival. <h3>Results</h3> In total 1738 patients (1040 [59.1%] male, median [range] age 39<sup>16–81</sup> years) with SpA initiating first TNFi were included in the analysis. Median disease duration was 116 months. 690 (39.7%) patients received adalimumab, 387 (22.3%) etanercept, 324 (18.6%) infliximab, 202 (11.6%) golimumab and 135 (7.8%) certolizumab. At the time of first biologic prescription 794 (45.7%) were using sulfasalazine or methotrexate. Baseline median BASDAI score was 60 (0–100), BASFI score was 46 (0–100), patient global assessment of disease activity was 70 (0–100), ESR was 23<sup>1–140</sup> mm/h and median CRP value was 13 (0–659) mg/L. In our study group median drug survival time was 12 (0–205) months. In total 585 (33.7%) of our patients stop their first TNFi. 323 (55.2) patients discontinued the medication due to inefficacy, 133 (22.7) due to adverse effect. Drug survival was significantly better in patients using concomitant csDMARDs at baseline (with a median survival 104 vs 30 months; p&lt;0.001; figure). In Cox regression model baseline age (HR 0.978, p=0.028), and concomitant csDMARD usage (HR 0.341, p&lt;0.001) were found to be as the predictors for better drug survival, female sex (HR 1.546, p=0.039), presence of psoriasis (HR 3.803, p=0.015), enthesitis (HR 1.619, p=0.018) and uveitis (HR 1.732, p=0.025) as predictors for worse drug survival. At the time of censoring only 202 (11.6%) patients were using csDMARDs with TNFi agent. When we repeat the analysis with patients continuing csDMARDs we showed that there is no significant differences regarding TNFi survival. <h3>Conclusions</h3> The results of present study showed that considerable amount of SpA patients were using csDMARDs at time of first TNFi initiating and drug survival was significantly better in those patients. <h3>Disclosure of Interest</h3> None declared