Ab0957 Profile of Real World Axial Spondyloarthritis Patients Refractory to Advanced Therapy

Background: Axial spondyloarthritis (AS) is an autoinflammatory disease in which biologic or targeted synthetic disease modifying drugs (DMARDs) therapy is widely used, with several targets and drugs to chose from. However, some patients are still somewhat refractory to the therapies that are provided to them. Objectives: To analyse the clinical and therapeutic characteristics in AS patients who have received at least three distinct advanced therapy (AT) lines. Methods: This is a retrospective longitudinal observational study of AS patients treated with at least 1 targeted therapy (TT). We analyse the different therapeutic lines administered, their duration and the causes of withdrawal. The patients are classified in non-refractory AS –those who have received up to 2 lines of TT– and refractory AS –those who have received 3 or more lines of therapy–. Results: 162 AS patients with TT treatment where included (62.4% men), with a mean age at diagnosis of 41 (13) years and a disease progression time since the beginning of the first TT of 20 (30) months. 59.1% of patients were HLA-B27 positive, 20.5% presented extraarticular manifestations (uveitis and/or inflammatory bowel disease) and 38.3% presented peripheral damage. 10 people required 3 or more different lines of therapy. In those patients, drug survival is shorter (P<0,001). The most used first line treatment was an anti-TNF, although it was less usual in patients with 3 or more therapy lines. The treatment change in second line was mainly due to switching, using cycling in third line of treatment. A tendency to more concomitant DMARD use is observed in people with more therapeutic lines (P=0.06). There is no statistically significant association between singular causes of withdrawal and the use of 3 or more therapeutic families. We also have not found an association between age or sex of patients and the use of more therapeutic lines. A correlation between the use of at least 3 different therapeutic families and the absence of extraarticular manifestations (P=0.01), presence of psoriasis (P=0.022) and anxious-depressive syndrome (P=0.001) have been observed. Table 1. Table 2. Conclusion: 6% of our AS patients required the use of at least 3 therapeutic families, with a mean of 4 lines of TT. The treatment with anti-TNF is less used in first and second line in patients who have required at least 3 therapeutic families, and the treatments are mainly modified through switching rather than cycling. The presence of other factors –such as psoriasis or anxious-depressive syndrome– seem to be associated with patients who require 3 or more therapeutic lines. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.