AB0944 PREDICTORS AT DIAGNOSIS FOR INITIATION OF BIOLOGIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS IN PATIENTS WITH SPONDYLOARTHRITIS
Authors: M. Hameed, S. Exarchou, A. Sharma, U. Bergström, J. T. Einarsson, C. Turesson
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The increasing use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) in the management of Spondyloarthritis (SpA) has markedly enhanced patient outcomes. Studies on predictors of bDMARD treatment initiation have yielded different results. <h3>Objectives:</h3> The aim of this study was to systematically investigate the relation between patient characteristics at the time of SpA diagnosis and the subsequent initiation of treatment with bDMARDs. <h3>Methods:</h3> This retrospective cohort study, spanning 2012-2016, enrolled consecutive adult patients diagnosed with spondyloarthritis (SpA) at the outpatient rheumatology clinic of Skåne University Hospital, Malmö, Sweden. Clinical data and information on treatment were systematically extracted through structured reviews of medical records. Data on treatment were also obtained from the Swedish National Quality Register (SRQ). Data regarding comorbidities were retrieved from the regional healthcare register covering utilization of both primary and secondary care. The Total Population Register held by the Statistics Sweden was the source of sociodemographic information including level of formal education, country of birth and family background. To elucidate the relationship between patient attributes at the time of diagnosis and the initiation of the first bDMARD, both unadjusted, age-sex-adjusted and multivariable Cox proportional hazards regression analyses were performed. Patients were censored at death, emigration from Sweden, or the end of the study on December 31, 2021. <h3>Results:</h3> Between 2012 and 2016 120 patients were diagnosed with SpA. The mean age at diagnosis was 38.2 years, and 64.2% were males. Fifty-one patients (42.5%) initiated treatment with a first bDMARD, with a median time from diagnosis to initiation of 7 months (inter quartile range (3 – 16). Patients with elevated C-reactive protein (CRP) levels [hazard ratio (HR) 2.68; 95% confidence interval (CI) 1.44 – 5.01], as well as those with evidence of bone marrow edema (BME) on the MRI of the sacroiliac joints (SIJ) (HR 1.94; 95% CI 1.02 – 3.70), were more likely to receive early bDMARD treatment, with similar results in age- and sex-adjusted models (Table 1). There was also a trend towards an association between peripheral arthritis at diagnosis and subsequent bDMARD treatment. No associations were observed between the initiation of bDMARDs and variables such as age, sex, education level, family background, or country of birth or comorbidities in this patient cohort. In the final multivariable model, elevated CRP and BME on the MRI of the SIJ were independent predictors for the initiation of bDMARD therapy (Table 2). <h3>Conclusion:</h3> In this retrospective cohort analysis, elevated CRP levels and evidence of active sacroiliitis on MRI, were predictive of subsequent bDMARD treatment. These findings underscore the importance of objective measures of inflammation for treatment decisions in early SpA. Sociodemographic factors did not impact bDMARD initiation, suggesting no major inequity in access to such treatment in this patient group. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Mohaned Hameed Novartis, Janssen Nordic, UCB, Sofia Exarchou AbbVie, Amgen, Janssen, Novartis, UCB Pharma, Ankita Sharma: None declared, Ulf Bergström: None declared, Jon Thorkell Einarsson: None declared, Carl Turesson AbbVie, Boehringer-Ingelheim, Nordic Drugs, Novartis, Pfizer, Roche.