AB0932 IMPACT OF A MULTIDISCIPLINARY SYSTEMATIC SCREENING PROGRAM FOR SPA COMORBIDITIES ON THERAPEUTIC MAINTENANCE OF bDMARDs AT 12 MONTHS
Authors: L. Vacher, A. Baillet, R. Gastaldi, L. Bouillet
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In the literature, data reporting the influence of comorbidities on bDMARD adherence are rare. <h3>Objectives:</h3> We aimed to evaluate the impact of a multidisciplinary systematic screening program for SpA comorbidities on therapeutic maintenance of b/DMARDs at 12 months. <h3>Methods:</h3> Data relating to screening for comorbidities were collected according to EULAR recommendations when initiating a bDMARDs, from December 2016 to April 2022. Adherence to recommendations and therapeutic maintenance of the bDMARD were assessed at 12 months. The adherent group is defined as having more than 80% of the recommendations followed at 12 months. The primary endpoint was maintenance of bDMARD at 12 months. The secondary endpoints were the withdrawal rates at 12 months bDMARDs for adverse events, and/or for ineffectiveness depending on adherence to recommendations. Qualitative variables were analysed using the Chi-square test. For quantitative variables, the Student t test was used in the case of Gaussian variables and the Wilcoxon Rank test in the case of non-Gaussian variables; bDMARD withdrawal time was analysed using Kaplan-Meier curves. A Cox model explaining the maintenance of bDMARD at 12 months was generated by including statistically significant parameters in the univariate analysis. <h3>Results:</h3> 561 patients with chronic inflammatory rheumatism were screened for eligibility; the analysis concerns 189 SpA patients. A total of 89 patients (47%) were in the adherent group and 100 patients (53%) in the non-adherent group to the recommendations at 12 months. Men were significantly less adherent to the recommendations (38/105=36% compared to only 51/84=61% among women, Odds ratio 0.5 IC 95 % [0.3-0.9]). Smoking patients adhered significantly less to the recommendations (10/43=33 % compared to 79/176=54% among non-smokers, Odds ratio 0.5 IC 95 % [0.1-0.6]). In the multivariate analysis gender was associated with withdrawal, Odds ratio concerning men Odds 0,4 IC95% [0,2 -0,7]. Smoking was inversely associated with adherence, Odds ratio 0.3 IC95% [0.1-0.6]. At 12 months, bDMARDs were stopped in 55 patients (29%). bDMARD withdrawal was linked to an adverse event in 31/189 (17%) patients and to an insufficient response in 27/189 (32%) patients. Adherence to anti-TNF was higher than other bDMARDs (76% versus 67% for anti-IL17 and anti-IL12/23, Odds ratio 5.1 95% CI [2.8-11.4]). Mean initial BASDAI was significantly higher in patients who discontinued bDMARD at M12 (5.0 (2.0) vs. 6.0 (2.0), p=0.04). Patients with sacroiliitis interrupted significantly more bDMARDs (29% compared to only 11% in patients without sacroiliitis, Odds ratio 3.2 95% CI [1.1-9.2]). Women discontinued bDMARD significantly more often (39% compared to only 19% in men, Odds ratio 2.4 IC 95% [1.3-4.6]). <h3>Conclusion:</h3> Female gender was associated with better adherence to systematic screening recommendations for comorbidities and with poorer bDMARD continuation at 12 months in patients with spondyloarthritis. Adherence to comorbidities screening recommendations was not associated with better bDMARD continuation at 12 months. <h3>REFERENCES:</h3> [1] 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis [2] Moltó A, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis, 2016 [3] Baillet A, et al. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative, Ann Rheum Dis, 2016 [4] Hubac J, et al. Implementation of comorbidities' systematic screening program in daily practice in France, JBS, 2020 [5] Reyes-Rivet L, et al. Adherence to EULAR's recommendations on comorbidity management minimizes the discontinuation of bDMARDS for intolerance in patients with chronic inflammatory rheumatic diseases, JBS, 2021 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>