Unmet needs in ankylosing spondylitis patients receiving tumour necrosis factor inhibitor therapy; results from a large multinational real-world study

Abstract

Background: Symptoms and comorbidities of ankylosing spondylitis (AS) considerably reduce health-related quality of life (HRQoL) and ability to work. This real-world study assessed rates of tumour necrosis factor inhibitor (TNFi) use and switching, treatment failure, and associations between failing TNFi and HRQoL, work productivity and activity impairment (WPAI). Methods: AS patients and their treating physicians completed questionnaires capturing patient demographics, clinical status, TNFi treatment history, reasons for switching TNFi, HRQoL and WPAI. Current TNFi was determined as "failing" if, after ≥3 months, physician-rated disease severity had worsened, remained severe, was "unstable/ deteriorating", physicians were dissatisfied with disease control and/or did not consider treatment a "success".Results: The analysis included 2866 AS patients from 18 countries. Of 2795 patients with complete treatment data, 916 (32.8%) patients had never received TNFi therapy, 1623 (58.1%) patients were receiving their 1st TNFi and 200 (7.2%) patients had ever received ≥2 TNFi (treatment switch). Primary or secondary lack of efficacy were the commonest reasons for switching, and the mean delay in switching after primary lack of efficacy was 11.1 months. 232 (15.4%) patients on TNFi were currently "failing" who, compared to those with treatment success, reported poorer HRQoL: 5-dimension EuroQoL (EQ-5D-3 L): 0.63 vs. 0.78; Medical Outcomes Study Short-Form Health Survey version 2 (SF-36v2) mental component summary (MCS): 41.8 vs. 46.3; physical component summary (PCS): 40.2 vs. 45.1; impaired work productivity: 46.4% vs. 25.0%; and activity: 44.5% vs. 29.6%; all P < 0.001. Conclusions: Among AS patients, switching TNFi is uncommon and delayed by nearly 1 year despite primary lack of efficacy. Patients currently failing TNFi experience worse physical function, HRQoL and work productivity.

Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients

“…[20][21][22] A study of 223 consecutive patients with r-axSpA, which examined long-term drug survival of TNFi treatment over a 10-year period, revealed that female patients had significantly lower treatment survival rates than men (33.4 vs 44.9 months; p=0.031). 23 Differences in immunological markers between male and female patients with axSpA have been reported in the literature and may be responsible for different treatment responses to TNFi. One study showed that male patients with axSpA have significantly higher levels of TNF and IL-17A than female patients.…”

The Association Between TNF Inhibitor Therapy Availability and Hospital Admission Rates for Patients with Ankylosing Spondylitis. A Longitudinal Population-Based Study

“…Finally, while not a primary aim of this study but because Australian data are lacking, we used these two datasets to estimate the population prevalence of AS. Based on the assumption that the 1925 AS patients that used a TNFi in 2020 represent 60% of all AS patients [16,17] in WA, the estimated point prevalence for AS was 0.29% in 2020. This figure agreed with the 0.28% period prevalence rate of AS amongst all hospital admissions in WA over 20 years (Suppl Fig.…”

Factors associated with the retention of secukinumab in patients with axial spondyloarthritis in real-world practice: results from a retrospective study (FORSYA)

“…5 Secukinumab has demonstrated significant long-term efficacy and safety versus placebo in patients with axSpA across various randomised clinical trials (RCTs). [6][7][8][9][10] RCTs evaluate sophisticated outcome measures including MRI, health-related quality of life with a stringent prospective, randomised and controlled design. 11 12 However, RCTs typically have a smaller and well-defined study population.…”