POS0027 SECULAR TRENDS IN BASELINE CHARACTERISTICS, TREATMENT RETENTION AND RESPONSE RATES IN 27189 BIO-NAÏVE AXIAL SPONDYLOARTHRITIS PATIENTS INITIATING TNFI – RESULTS FROM THE EUROSPA COLLABORATION
Authors: L. Midtbøll Ørnbjerg, S. N. Christiansen, S. H. Rasmussen, A. G. Loft, U. Lindström, J. Zavada, F. Iannone, F. Onen, M. J. Nissen, B. Michelsen, M. J. Santos, G. Macfarlane, D. Nordström, M. Pombo-Suarez, C. Codreanu, M. Tomsic, I. Van der Horst-Bruinsma, B. Gudbjornsson, J. Askling, B. Glintborg, K. Pavelka, E. Gremese, N. Akkoc, A. Ciurea, E. Kristianslund, A. Barcelos, G. T. Jones, A. M. Hokkanen, C. Sánchez-Piedra, R. Ionescu, Z. Rotar, M. G. H. Van de Sande, A. J. Geirsson, M. Østergaard, M. L. Hetland
Journal: Annals of the Rheumatic Diseases (2021)

Background: Knowledge of changes over time in baseline characteristics and tumor necrosis factor inhibitor (TNFi) response in bio-naïve axial spondyloarthritis (axSpA) patients treated in routine care is limited. Objectives: To investigate secular trends in baseline characteristics and retention, remission and response rates in axSpA patients initiating a first TNFi. Methods: Prospectively collected data on bio-naïve axSpA patients starting TNFi in routine care from 15 European countries were pooled. According to year of TNFi initiation, three groups were defined a priori based on bDMARD availability: Group A (1999–2008), Group B (2009–2014) and Group C (2015–2018). Retention rates (Kaplan-Meier), crude and LUNDEX adjusted 1 remission (Ankylosing Spondylitis Disease Activity Score (ASDAS) &lt;1.3, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) &lt;20) and response (ASDAS Major and Clinically Important Improvement (MI/CII), BASDAI 50) rates were assessed at 6, 12 and 24 months. No statistical comparisons were made. Results: In total, 27189 axSpA patients were included (5945, 11255 and 9989 in groups A, B and C). At baseline, patients in group A were older, had longer disease duration and a larger proportion of male and HLA-B27 positive patients compared to B and C, whereas disease activity was similar across groups. Retention rates at 6, 12 and 24 months were highest in group A (88%/81%/71%) but differed little between B (84%/74%/64%) and C (85%/76%/67%). In all groups, median ASDAS and BASDAI had decreased markedly at 6 months (Table 1). The ASDAS values at 12 and 24 months and BASDAI at 24 months were higher in group A compared with groups B and C. Similarly, crude remission and response rates were lowest in group A. After adjustments for drug retention (LUNDEX), remission and response rates showed less pronounced between-group differences regarding ASDAS measures and no relevant differences regarding BASDAI measures. Conclusion: Nowadays, axSpA patients initiating TNFi are younger with shorter disease duration and more frequently female and HLA-B27 negative than previously, while baseline disease activity is unchanged. Drug retention rates have decreased, whereas crude remission and response rates have increased. This may indicate expanded indication but also a stable disease activity threshold for TNFi initiation over time, an increased focus on targeting disease remission and more available treatment options. References: [1]Arthritis Rheum 2006; 54: 600-6. Table 1. Secular trends in baseline characteristics, treatment retention, remission and response rates in European axSpA patients initiating a 1 st TNFi Baseline characteristics Group A (1999–2008) Group B (2009–2014) Group C (2015–2018) Age, years, median (IQR) 57 (49–66) 51 (42–60) 46 (37–56) Male, % 66 60 57 HLA-B27, % 87 77 72 Years since diagnosis, median (IQR) 5 (1–12) 2 (0–8) 2 (0–7) Smokers, % 23 24 25 ASDAS, median (IQR) 3.5 (2.8–4.1) 3.4 (2.8–4.1) 3.5 (2.8–4.1) BASDAI, median, (IQR) 57 (42–71) 59 (43–72) 57 (41–71) TNFi drug, % (Adalimumab / Etanercept / Infliximab / Certolizumab / Golimumab) 22 / 35 / 43 / 0 / 0 37 / 21 / 20 / 4 / 18 27 / 28 / 24 / 8 / 13 Follow up 6 months 12 months 24 months Gr A Gr B Gr C Gr A Gr B Gr C Gr A Gr B Gr C Retention rates, %, (95% CI) 88 (88–89) 84 (83–85) 85 (84–86) 81 (80–82) 74 (74–75) 76 (75–76) 71 (70–72) 64 (63–65) 67 (66–68) ASDAS , median, (IQR) 1.8 (1.2–2.8) 1.9 (1.2–2.8) 1.8 (1.2–2.6) 1.9 (1.3–2.6) 1.7 (1.2–2.5) 1.6 (1.1–2.4) 1.9 (1.4–2.6) 1.7 (1.1–2.4) 1.5 (1.1–2.2) ASDAS inactive disease , %, c/L 28 / 25 28 / 24 30 / 26 24 / 19 32 / 24 34 / 26 23 / 16 34 / 20 39 / 23 ASDAS CII , %, c/L 57 / 51 59 / 50 63 / 54 61 / 50 63 / 47 67 / 51 59 / 41 68 / 40 74 / 45 ASDAS MI , %, c/L 31 / 27 32 / 27 37 / 32 32 / 26 37 / 27 41 / 31 30 / 20 42 / 25 46 / 28 BASDAI , median, (IQR) 23 (10–40) 26 (11–48) 24 (10–44) 21 (10–38) 23 (10–42) 20 (8–39) 22 (9–40) 20 (8–39) 16 (6–35) BASDAI remission , %, c/L 44 / 40 40 / 34 43 / 36 45 / 36 45 / 34 50 / 38 44 / 30 48 / 29 56 / 34 BASDAI 50 response , %, c/L 53 / 47 50 / 42 53 / 45 57 / 46 56 / 42 58 / 44 57 / 39 60 / 35 63 / 38 Gr, Group; c/L, crude/LUNDEX adjusted. Acknowledgements: Novartis Pharma AG and IQVIA for supporting the EuroSpA Research Collaboration Network. Disclosure of Interests: Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Sara Nysom Christiansen Speakers bureau: BMS and GE, Grant/research support from: Novartis, Simon Horskjær Rasmussen: None declared, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Grant/research support from: Novartis, Ulf Lindström: None declared, Jakub Zavada: None declared, Florenzo Iannone: None declared, Fatos Onen: None declared, Michael J. Nissen Speakers bureau: Novartis, Eli Lilly, Celgene, and Pfizer, Consultant of: Novartis, Eli Lilly, Celgene, and Pfizer, Brigitte Michelsen Consultant of: Novartis, Grant/research support from: Novartis, Maria Jose Santos Speakers bureau: AbbVie, Novartis, Pfizer, Gary Macfarlane Grant/research support from: GlaxoSmithKline, Dan Nordström Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, Roche, UCB, Manuel Pombo-Suarez: None declared, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Irene van der Horst-Bruinsma Speakers bureau: Abbvie, BMS, MSD, Novartis, Pfizer, Lilly, UCB, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Johan Askling: None declared, Bente Glintborg Grant/research support from: Pfizer, Biogen, AbbVie, Karel Pavelka Speakers bureau: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Consultant of: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Elisa Gremese: None declared, Nurullah Akkoc: None declared, Adrian Ciurea Speakers bureau: Abbvie, Eli-Lilly, MSD, Novartis, Pfizer, Eirik kristianslund: None declared, Anabela Barcelos: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene, Amgen, GSK, Anna-Mari Hokkanen Grant/research support from: MSD, Carlos Sánchez-Piedra: None declared, Ruxandra Ionescu Speakers bureau: Abbvie, Amgen, Boehringer-Ingelheim Eli-Lilly,Novartis, Pfizer, Sandoz, UCB, Ziga Rotar Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Marleen G.H. van de Sande: None declared, Arni Jon Geirsson: None declared, Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth, Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth, Merete L. Hetland Speakers bureau: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis.