Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor [alpha] inhibitor therapy: results from the Danish nationwide DANBIO registry

• Published in: Annals of the rheumatic diseases Vol. 72; no. 7; p. 1149
• Main Authors: Glintborg, Bente, Ã~stergaard, Mikkel, Krogh, Niels Steen, Tarp, Ulrik, Manilo, Natalia, Loft, Anne Gitte Rasmussen, Hansen, Annette, Schlemmer, Annette, Fana, Victoria, Lindegaard, Hanne M, Nordin, Henrik, Rasmussen, Claus, Ejstrup, Leif, Jensen, Dorte Vendelbo, Petersen, Peter Mosborg, Hetland, Merete Lund
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2013
• Subjects: Arthritis; Biological products; Drug dosages; Gangrene; Pain; Rheumatology; Studies; Surgery; Denmark
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2012-201933

Objective To investigate frequencies and reasons for switching, treatment responses and drug survival in patients with ankylosing spondylitis (AS) switching tumour-necrosis-factor-α inhibitor (TNFi) treatment in routine clinical care. Methods AS patients were identified in the Danish nationwide DANBIO registry. Disease activity, treatment responses (50% or 20 mm reduction in Bath AS Disease Activity Index (BASDAI)), duration and rates of drug survival and predictors thereof were studied in patients receiving â[per thousand]¥2 different biological drugs. Results Of 1436 AS patients starting TNFi treatment, 432 patients (30%) switched to a second and 137 (10%) to a third biological drug. Compared with non-switchers, switchers were more frequently women (33%/22%), had shorter disease duration (3 years/5 years) and higher BASDAI (62(52â[euro]"76) mm/56(43â[euro]"69) mm (median(interquartile-range))), Bath AS Functional Index (BASFI) (54(39â[euro]"71) mm/47(31â[euro]"65) mm) and visual-analogue-scale (VAS) global, pain and fatigue scores when they started the first TNFi (all p<0.01). Main reason for switching was lack of response (56%). During the first, second and third treatment BAS- and VAS scores had decreased after 6 months' treatment (all p<0.05). Median drug survivals were 3.1, 1.6 and 1.8 years respectively (p<0.001). After 2 years of treatment 52% of switchers and 63% of non-switchers had achieved response (number needed to treat 1.9 and 1.6, respectively, p=0.01). Drug survivals were similar regardless of the reason for switching. Male gender and low BASFI predicted drug survival of the second TNFi. Conclusions Nearly one-third of AS patients in clinical practice switched biological treatment. Response rates and drug survivals were lower among switchers, however, half of switchers achieved treatment response.