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Abstract
Objectives To assess the impact of extra-articular spondyloarthritis (SpA) manifestations (anterior uveitis, psoriasis and inflammatory bowel disease (IBD)), and of comorbidities, on tumour necrosis factor alpha inhibitor (TNFi) drug retention in ankylosing spondylitis (AS).
Methods We identified all bio-naïve patients with AS starting a first ever TNFi July 2006 to December 2015 from the Swedish Rheumatology Quality register and followed these from treatment start through December 2015. We determined the presence of extra-articular SpA-manifestations, comorbidities (cardiovascular disease, affective disease, diabetes, malignancies, chronic lung disease and kidney disease) and socioeconomic status before TNFi start, through linkage to five other national registers, and calculated, for each factor, crude and adjusted HRs for discontinuing the TNFi.
Results 2577 patients with AS (71% men) started a first TNFi during the study period. 27% had a history of anterior uveitis, 6% psoriasis and 7% IBD. Anterior uveitis was associated with a superior TNFi drug retention (HR 0.72; 0.62 to 0.83), psoriasis with an inferior (HR 1.48; 1.18 to 1.86), whereas IBD did not affect TNFi drug retention. The effect of the SpA manifestations on TNFi drug retention was of a similar magnitude to that of the comorbidities.
Conclusions In AS, anterior uveitis and psoriasis, but not IBD, affect TNFi drug retention. Possible explanations include differential effects of TNFi on these extra-articular SpA manifestations, or inherent differences in AS, associated with the inflammatory phenotype. Further, comorbidities and socioeconomy affect TNFi drug retention to a similar magnitude as the SpA manifestations, and should, as such, receive due attention in clinical practice.
- ankylosing spondylitis
- anti-TNF
- treatment
- epidemiology
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Footnotes
Contributors All authors have contributed substantially in the process of completing this study and had full access to the data, specified as follows: conception of the study: UL and JA. Designing the study: All authors. Aggregation of data and statistical analysis: UL. Interpretation of data: all authors. Drafting and revising, final approval and agreement to be accountable: all authors.
Funding The ARTIS Study Group conducts scientific analyses using data from the Swedish Biologics Register, run by the Swedish Society for Rheumatology. To this end, Karolinska Institutet has entered into agreements with Abbvie, BMS, Lilly, Merck, Pfizer, Roche, Samsung Bioepis, and UCB. These entities had no influence on the data collection, statistical analyses, manuscript preparation or decision to submit. Companies whose drugs were studied were allowed to comment upon the findings prior to submission although all final decisions resided with the investigators.
Competing interests JA has entered into agreements with Abbvie, BMS, Lilly, Merck, Pfizer, Roche, Samsung Bioepis, and UCB, mainly for safety monitoring via the Swedish ARTIS system (see above), and received a travel reimbursement from Novartis. Karolinska Institutet has received remuneration for JA’s participation in meetings arranged by Pfizer and by Lilly.
Patient consent Not required.
Ethics approval The regional ethical committee in Stockholm, Sweden, approved the study (dnr:2011/29-31/1).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Technical appendix and statistical codes are available from the corresponding author at request.