نبذة مختصرة : Objectives Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. Methods Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP < 1.3 and/or BASDAI < 2) and stratified by treatment. Inter-registry heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Peripheral arthritis was defined as >= 1 swollen joint at baseline (=TNFi start). Results Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P < 0.001). Remission was obtained in 20% on monotherapy and 22% on co-therapy (P < 0.001); adjusted OR of 1.16 (1.07, 1.25). Remission rates at 12 months were similar in patients with/without peripheral arthritis. Conclusion This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy. ; Peer reviewed
Relation: This work was supported by Novartis. Novartis had no influence on the data collection, statistical analyses, manuscript preparation or decision to submit.; Nissen , M , Delcoigne , B , Di Giuseppe , D , Jacobsson , L , Hetland , M L , Ciurea , A , Nekvindova , L , Iannone , F , Akkoc , N , Sokka-Isler , T , Fagerli , K M , Santos , M J , Codreanu , C , Pombo-Suarez , M , Rotar , Z , Gudbjornsson , B , Van der Horst-Bruinsma , I , Loft , A G , Moeller , B , Mann , H , Conti , F , Cetin , G Y , Relas , H , Michelsen , B , Ribeiro , P A , Ionescu , R , Sanchez-Piedra , C , Tomsic , M , Geirsson , A J , Askling , J , Glintborg , B & Lindström , U 2022 , ' The impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondylarthritis ' , Rheumatology , vol. 61 , no. 12 , pp. 4741-4751 . https://doi.org/10.1093/rheumatology/keac174; http://hdl.handle.net/10138/575581; c92939b4-34dd-46c0-82a7-b041631b3870; 000784112300001
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