OBJECTIVES: To investigate time trends in baseline characteristics and retention, remission and response rates in bio-naïve axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients initiating TNF inhibitor (TNFi) treatment. METHODS: Prospectively collected data on bio-naïve axSpA and PsA patients from routine care in 15 European countries were pooled. Three cohorts were defined according to year of TNFi initiation: A (1999-2008), B (2009-2014) and C (2015-2018). Retention, remission and response rates were assessed at 6, 12 and 24 months. RESULTS: In total, 27 149 axSpA and 17 446 PsA patients were included. Cohort A patients had longer disease duration compared with B and C. In axSpA, cohort A had the largest proportion of male and HLA-B27 positive patients. In PsA, baseline disease activity was highest in cohort A. Retention rates in axSpA/PsA were highest in cohort A and differed only slightly between B and C. For all cohorts, disease activity decreased markedly from 0 to 6 months. In axSpA, disease activity at 24 months was highest in cohort A, where also remission and response rates were lowest. In PsA, remission rates at 6 and 12 months tended to be lowest in cohort A. Response rates were at all time points comparable across cohorts, and less between-cohort disease activity differences were seen at 24 months. CONCLUSION: Our findings indicate that over the past decades, clinicians have implemented more aggressive treatment strategies in spondyloarthritis. This was illustrated by shorter disease duration at treatment initiation, decreased retention rates and higher remission rates during recent years.

Aberdeen Centre for Arthritis and Musculoskeletal Health School of Medicine Medical Sciences and Nutrition University of Aberdeen Aberdeen UK

Carol Davila University of Medicine and Pharmacy Bucharest Romania

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

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopedics Copenhagen University Hospital Rigshospitalet Glostrup

DANBIO registry Copenhagen University Hospital Rigshospitalet Glostrup Denmark

Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Rheumatology Aarhus University Hospital Aarhus

Department of Rheumatology Amsterdam UMC Location VUmc Amsterdam Netherlands

Department of Rheumatology and Centre for Rheumatology Research University Hospital Reykjavik Iceland

Department of Rheumatology and Clinical Immunology Amsterdam institute for Infection and Immunity Amsterdam Rheumatology and Immunology Center Amsterdam UMC AMC University of Amsterdam Amsterdam Netherlands

Department of Rheumatology Centro Hospitalar do Baixo Vouga Aveiro Portugal

Department of Rheumatology East Tallinn Central Hospital Tallinn Estonia

Department of Rheumatology Geneva University Hospital Geneva Switzerland

Department of Rheumatology University Hospital Zurich Zurich Switzerland

Department of Rheumatology University Medical Centre Ljubljana and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Division of Rheumatology and Research Diakonhjemmet Hospital Oslo

Division of Rheumatology Celal Bayar University School of Medicine Manisa Turkey

Division of Rheumatology Department of Medicine Hospital of Southern Norway Trust Kristiansand Norway

Division of Rheumatology Dokuz Eylul University School of Medicine Izmir Turkey

Hospital Garcia de Orta Rheumatology Department Reuma Pt Registry Portugal

Inflammation Center Rheumatology Helsinki University Hospital and University of Helsinki Helsinki Finland

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

Research Unit Sociedad Española de Reumatologia Madrid Spain

Rheumatology Division Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Rheumatology Service Hospital Clinico Universitario Santiago de Compostela Spain

Rheumatology Unit University of Bari Bari Italy

References provided by Crossref.org

Challenge of missing data in observational studies: investigating cross-sectional imputation methods for assessing disease activity in axial spondyloarthritis

Second and third TNF inhibitors in European patients with axial spondyloarthritis: effectiveness and impact of the reason for switching

Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries