Pos0811 Impact of Disease Manifestations on First Biologic Drug Survival in Axial Spondyloarthritis: A Real-World Canadian Study

Background: Axial spondyloarthritis (axSpA) is characterized by different disease manifestations including peripheral musculoskeletal features and extra-musculoskeletal manifestations (EMMs). AxSpA is often managed with biologic disease-modifying antirheumatic drugs (bDMARD) and in real-world settings, drug survival is an important surrogate measure of effectiveness and tolerability. However, few studies have investigated the impact of these disease manifestations on biologic drug survival. Objectives: The primary objective of this study was to assess the impact of EMMs (acute anterior uveitis AAU, psoriasis, nail psoriasis, inflammatory bowel disease IBD or any EMMs) and peripheral musculoskeletal manifestations (peripheral arthritis, enthesitis, dactylitis or any peripheral musculoskeletal manifestation) on first bDMARD drug survival. The secondary objective was to evaluate the impact of reasons for treatment discontinuation on drug survival for each disease manifestation. Methods: 593 axSpA subjects from the SpondyloArthritis Research Consortium of Canada (SPARCC) registry initiating a first biologic drug were identified between 2003 and 2023. Drug survival was presented using Kaplan-Meier curves for each disease manifestation, and differences between groups were assessed using log-rank test. A Cox proportional hazard regression model was used to analyze independent predictors of discontinuation. The impact of reasons for treatment discontinuation on drug survival for each disease manifestation was assessed with competing risk analysis, and comparisons between groups were done using Gray's test. Results: At time of bDMARD initiation, mean age was 38.0±13.3 years, 64% were male and 76% were HLA-B27 positive. A total of 570 subjects started an anti-tumor necrosis factor (TNFi) and 23 subjects started an anti-interleukin-17 (IL-17i). Psoriasis was noted in 19% of the cohort, nail psoriasis in 6%, AAU in 33% and IBD in 13%. In unadjusted analyses, the presence of either psoriasis, nail psoriasis, dactylitis, at least one EMM or at least one peripheral musculoskeletal manifestation was associated with prolonged drug survival compared to those without these conditions (see Figure 1). A similar effect was not observed for AU, IBD, peripheral arthritis and enthesitis. In multivariable analysis, male sex (HR 0.47 95% CI, 0.35-0.65), the presence of psoriasis (HR 0.52; 95% CI, 0.32-0.85) and at least one peripheral musculoskeletal manifestation (HR 0.68; 95% CI, 0.49-0.94) were independently associated lower risk for biologic discontinuation (see Table 1). In patients with a history of psoriasis or dactylitis, longer bDMARD drug survival was observed when the medication was stopped for lack of effectiveness (pConclusion: In this real-world Canadian study, we found that axSpA disease manifestations had an impact on biologic drug survival. Psoriasis and peripheral musculoskeletal manifestations were independently associated with a lower risk for discontinuation. In addition, the impact of psoriasis on drug survival was not secondary to rates of adverse events suggesting that psoriasis may directly influence treatment response in these axSpA patients. Future research will be needed to further refine treatment strategies in axSpA according to specific disease manifestation. REFERENCES: NIL. Acknowledgements: The authors would like to thank Maria Morales, Jennifer Dutra and Hanane Maames for their assistance. We would also like to acknowledge the SPARCC investigators for their contributions to data collection and the participants of the SPARCC registry. Disclosure of Interests: Raphaël Hurtubise: None declared, Sherry Rohekar Abbvie, Amgen, BioJAMP, BMS, Celgene, Celltrion, Eli-Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Organon, Pfizer, Roche, Sandoz, UCB, Viatris, UCB, Nigil Haroon: None declared, Zeynep Baskurt: None declared, Tina Chim: None declared, Michel Zummer Viatris, Abbvie, Fresenius Kabe, Janssen, Organon, UCB, Robert Inman Abbvie, Janssen, UCB, Novartis, Novartis, Nicolas Richard Abbvie, Fresenius-Kabi, Novartis, Abbvie, Astra-Zeneca, Eli-Lilly, Novartis, UCB, Abbvie, Novartis, Janssen.