Treatment satisfaction, disease severity and healthcare use in patients with axial spondyloarthritis in the United States and Europe

Objectives The heterogeneous presentation of axial spondyloarthritis (axSpA) complicates diagnosis and treatment decisions. This study compared patient symptoms, healthcare resource utilisation and physician-patient alignment on disease severity and treatment satisfaction between the United States (US) and five European countries (5EU). Methods Data were drawn from the Adelphi axSpA Disease Specific Programme (DSP)™, a real-world cross-sectional survey conducted in the US and 5EU between March and November 2021. Rheumatologists reported on consecutive patients, including clinical characteristics, disease severity, symptomatic burden, treatment history, healthcare resource utilisation, and treatment satisfaction. Patients reported on disease severity, treatment satisfaction, and other validated patient-reported outcome measures. Physician-patient alignment was quantified using weighted kappa analyses. Results 351 rheumatologists provided data for 2,750 patients (US = 656, 5EU = 2,094), of whom 1,011 (36.8%) self-reported data. Mean [standard deviation (SD)] number of symptoms at diagnosis were similar (US: 6.0 [4.4] vs 5EU: 6.4 [4.3]; p= 0.0657), however mean [SD] at data collection was greater in the US than 5EU (3.3 [3.3] vs 2.3 [2.8] respectively; p< 0.0001). Physician-patient alignment on disease severity at diagnosis (κ = 0.37 vs κ = 0.47), treatment initiation (κ = 0.32 vs κ = 0.42) and data collection (κ = 0.32 vs κ = 0.61), and treatment satisfaction (κ = 0.35 vs κ = 0.42) were lower in US than 5EU. Mean [SD] consultations in the previous 12 months were lower in the US than 5EU (5.2 [3.4] vs 6.5 [5.1]; p= 0.0008), although mean hospitalisations were similar. Conclusion Differences in symptomatic burden and care were observed between regions. Identifying care gaps will aid in implementing targeted improvements in treatment, minimising the risk of health inequalities.