Pos0809 Switch or Swap? Second Targeted Therapy Choice in Patients With Spondyloarthritis: A Cohort Study Within the French National Health Data System (Snds)

Background: Objectives: Our objective was to describe the cumulative incidence of intra-class (switch) or inter-class (swap) therapeutic changes following the initiation of a first targeted therapy in patients treated for spondyloarthritis (SpA). Methods: This retrospective cohort study within the French National Health Data System (SNDS), included adult subjects diagnosed with SpA, including axial SpA and psoriatic arthritis, who received a first targeted therapy between 01/01/2015 and 31/12/2018. The therapeutic classes considered for defining intra-class switches and swaps were anti-TNF, anti-IL17, anti-IL23, anti-IL12/23, Janus Kinase inhibitor (JAKi), and phosphodiesterase-4 inhibitor (PD4i). Results: A total of 36,039 SpA patients initiating a first targeted therapy were identified, with a median age at initiation of 45 years (IQR [35.3-54.9]) and 56% women. Among the included subjects, 33,840 (93.9%) had a diagnosis of axial SpA, and 8,839 (24.53%) had psoriatic arthritis. The cumulative incidence of a second targeted therapy was 25.6% (CI95%: 25.1-26.1) at 1 year and 51.1% at 5 years (50.5-51.8). The initial therapy was a monoclonal anti-TNF antibody, a TNF receptor, and an anti-IL17 in 62.9%, 24.3%, and 4.3% of cases, respectively. Switch rates were 18.4%, 25.6%, 29.5%, and swap rates were 7.2%, 11.3%, and 13.8% at 1, 2, and 3 years, respectively. Compared to subjects offered a switch, subjects offered a swap appeared slightly older (median age of 47.4 years (IQR [37.8-55.9]) vs. 42.6 years (IQR [33.99-51.84]) and with a higher proportion of women (67.2% vs. 62.6%). The most frequent types of swaps were from a monoclonal anti-TNF antibody to an anti-IL17 (n=1697, 35.0%) and from a TNF receptor to an anti-IL17 (n=518, 10.69%). A total of 319 subjects (6.6%) received an anti-TNF after an anti-IL17 as the first-line therapy. Among patients with a first-line anti-TNF and a subsequent switch, 75.0% received another anti-TNF, 17.9% received an anti-IL17, and 7.1% received another treatment. Conclusion: This analysis of SNDS data provides insight into the use of biologics in France during the pre-COVID-19 period. Although anti-TNF agents remained the most commonly used therapeutic class as a first-line treatment, anti-IL17 prescriptions were observed in 4.3% of cases. Moreover, this study suggests the feasibility of a prospective study comparing the options of anti-TNF to anti-IL17 versus anti-IL17 to anti-TNF in terms of response rates in second line and the therapeutic maintenance of either options. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.