OBJECTIVE: To study drug retention and response rates in patients with axial spondyloarthritis (axSpA) initiating a first tumour necrosis factor inhibitor (TNFi). METHODS: Data from 12 European registries, prospectively collected in routine care, were pooled. TNFi retention rates (Kaplan-Meier statistics), Ankylosing Spondylitis Disease Activity Score (ASDAS) Inactive disease (<1.3), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <40 mm and Assessment of SpondyloArthritis International Society responses (ASAS 20/40) were assessed at 6, 12 and 24 months. RESULTS: A first TNFi was initiated in 24 195 axSpA patients. Heterogeneity of baseline characteristics between registries was observed. Twelve-month retention was 80% (95% CI 79% to 80%), ranging from 71% to 94% across registries. At 6 months, ASDAS Inactive disease/BASDAI<40 rates were 33%/72% (LUNDEX-adjusted: 27%/59%), ASAS 20/40 response rates 64%/49% (LUNDEX-adjusted 52%/40%). In patients initiating first TNFi after 2009, 6097 patients was registered to fulfil ASAS criteria for axSpA, 2935 was registered to fulfil modified New York Criteria for Ankylosing Spondylitis and 1178 patients was registered as having non-radiographic axSpA. In nr-axSpA patients, we observed lower 12-month retention rates (73% (70%-76%)) and lower 6-month LUNDEX adjusted response rates (ASDAS Inactive disease/BASDAI40 20%/50%, ASAS 20/40 45%/33%). For patients initiating first TNFi after 2014, 12-month retention rate, but not 6-month response rate, was numerically higher compared with patients initiating TNFi in 2009-2014. CONCLUSION: A large European database of patients with axSpA initiating a first TNFi treatment in routine care, demonstrated that 27% of patients achieved ASDAS inactive disease after 6 months, while 59% achieved BASDAI <40. Four of five patients continued treatment after 1 year.

Amsterdam UMC Department of Rheumatology VU University Medical Centre Amsterdam Amsterdam The Netherlands

biorx si and the Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia

Centre for Rheumatology Research University Hospital and Faculty of Medicine University of Iceland Reykjavik Iceland

Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden

DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Rheumatology Geneva University Hospital Geneva Switzerland

Department of Rheumatology RRBR Registry and University of Medicine and Pharmacy Carol Davila Bucharest Romania

Department of Rheumatology University Hospital of Iceland Reykjavik Iceland

Department of Rheumatology Zurich University Hospital Zurich Switzerland

Epidemiology Group School of Medicine Medical Science and Nutrition University of Aberdeen Aberdeen UK

EuroSpA Coordinating Center Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

GISEA Registry Rheumatology Unit DETO University of Bari Bari Italy

Inflammation Center Department of Rheumatology Helsinki University Hospital Helsinki Finland

Institute of Rheumatology Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

NOR DMARD Registry Department of Rheumatology Diakonhjemmet Hospital Oslo Norway

Research Unit Spanish Society of Rheumatology Madrid Spain

Reuma pt registry and Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisbon Portugal

Rheuma pt registry Rheumatology Department Centro Hospitalar do Baixo Vouga and Ibimed Institute for Biomedicine University of Aveiro Aveiro Portugal

ROB FIN Registry Helsinki University and Helsinki University Hospital Helsinki Finland

TURKBIO Registry Division of Rheumatology School of Medicine Dokuz Eylul University Izmir Turkey

Zitelabs Aps Copenhagen Denmark

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