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Background: If classical antirheumatic therapy fails, the next treatment step for psoriatic arthritis (PsA) and spondyloarthritis (SpA) is biological (bDMARDs) or targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) therapy. The retention rate of biologicals in these patients is suboptimal. The identification of an effective treatment often necessitates multiple therapeutic attempts, causing a significant burden on therapy compliance and healthcare costs. Since the approval of IL-17-inhibitors in 2017 in the Netherlands, rheumatologists have more treatment options available if initial b/tsDMARD therapy fails, which might have reduced the retention rates of biologicals in recent years. Objectives: The objectives in this study were the following: (a) to determine the 1-year retention rate of the first b/tsDMARD treatment in PsA and SpA patients divided in two time periods: 2012-2016 and 2017-2022 and (b) to investigate whether the retention rates between the different bDMARD treatments in the aforementioned time periods differed. Methods: We performed a single-centre database study at the Reade Amsterdam outpatient clinic. All patients received a least one dose of b/tsDMARD treatment between January 2012 and December 2022. At baseline patient characteristics, diagnosis, use of csDMARDs, b/tsDMARD treatments, BSE, CRP, and several disease activity scores (TJC/SJC 66/68, LEI, PASI, BASDAI, BASMI, BASFI, DAS-28, ASDAS-CRP) were collected. Additionally, 3-month, 6-month and 1-year follow up data were collected. Follow up data comprised switch or stop of biological treatment, laboratory parameters and aforementioned disease severity scores. To determine statistically differences in 1-year retention rates between groups, log rank tests were used. Results: In total, five hundred and eighty-seven patients were included. Three hundred and twenty patients were included in the PsA group, mean age 47.5 years. Two hundred and sixty-seven patients were included in the SpA group, mean age 41.4 years. Patients initiated biological treatment were more often men (PsA 56.6% and SpA 61.4%) with mean 6.6 (PsA) and 7.4 (SpA) years between diagnosis and start of the first biological treatment. 1-year retention rate in the PsA group was 77.6% between 2012-2016 and 74.0% between 2017-2022 (p=0.61). In the SpA group the 1-year retention rate was 73.2% between 2012-2016 and 67.0% between 2017-2022 (p=0.46). The 1-year retention rates for the predominantly prescribed TNF-inhibitors, adalimumab and etanercept, were 76.7% and 80.2% between 2012-2016 and 70.9% and 68.1% between 2017-2022. No significant differences were found in retention rates between the two time periods for adalimumab (p=0.55) and etanercept (p=0.12). Conclusion: Although the 1-year retention rates in both PsA and SpA groups who received their first b/tsDMARD treatment between 2012-2016 were numerically slightly higher than in the groups who received their first dose of b/tsDMARD between 2017-2022, no statistically significant difference was found. Specific patient profiles for failure on the first bDMARD/tsDMARD therapy could not be identified. REFERENCES: NIL. Acknowledgements: This study was partially funded by Novartis. Disclosure of Interests: None declared.
Jong et al. (Sat,) studied this question.