First-line biologic therapy persists longer than later agents in ankylosing spondylitis

Biologic disease-modifying antirheumatic drug (bDMARD) therapy is effective in reducing ankylosing spondylitis (AS) disease activity, reports a study, noting how treatment has persisted for up to 8 years among patients remaining on their first bDMARD, which is longer than on subsequent agents.

In this retrospective, noninterventional cohort study, the investigators extracted data from AS patients from the Optimising Patient outcomes in Australian RheumatoLogy (OPAL) dataset from August 2006 to September 2019. They classified patients as either bDMARD initiators if they initiated a bDMARD during the sampling window, or bDMARD-naïve if they did not.

The findings were summarized descriptively. Treatment persistence was calculated using Kaplan-Meier methods, while its differences were assessed using log-rank tests.

A total of 5,048 AS patients were identified, of whom 2,597 initiated bDMARDs and 2,451 remained bDMARD-naïve throughout the study window.

Treatment with first-, second-, and third-line bDMARDs all resulted in significant reductions in AS disease activity.

Median persistence on first-line bDMARDs was 96 months (95 percent confidence interval [CI], 85‒109), which dropped to 19 months (95 percent CI, 16‒22) on second-line therapy and 15 months (95 percent CI, 11‒18) on third-line therapy.

In all lines of therapy, median persistence was longest for golimumab and shortest for etanercept. Differences in persistence rates based on the time period that bDMARDs were prescribed (pre- and post-2012) were also observed for etanercept and adalimumab.

“Further research is needed to determine its influence on treatment recommendations,” the investigators said.