The occurrence of multiple treatment switches in axial spondyloarthritis. Results from five Nordic rheumatology registries

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MARC

Di Giuseppe, D.Karolinska Institutet (author)

The occurrence of multiple treatment switches in axial spondyloarthritis. Results from five Nordic rheumatology registries

Article/chapterEnglish2022

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2021-12-23
Oxford University Press (OUP),2022

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LIBRIS-ID:oai:gup.ub.gu.se/313866
https://gup.ub.gu.se/publication/313866URI
https://doi.org/10.1093/rheumatology/keab946DOI
http://kipublications.ki.se/Default.aspx?queryparsed=id:148778095URI

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Language:English

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SwePubSwePub

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Objectives In axial spondyloarthritis (axSpA), switching between multiple biologic or targeted synthetic (b/ts-) DMARDs might indicate difficult-to-treat disease. We aimed to explore the occurrence of multiple switching in routine care axSpA patients using various definitions, and to identify associated clinical characteristics upon start of first b/tsDMARD (baseline). Methods Observational cohort study including patients with axSpA starting a first-ever b/tsDMARD 2009-2018 based on data from five biologic registries (Denmark/Sweden/Finland/Norway/Iceland). Comorbidities and extra-articular manifestations were identified through linkage to national registries. Multi-switching was defined in overlapping categories according to b/tsDMARD treatment history: treatment with >= 3, >= 4 or >= 5 b/tsDMARDs during follow-up. We explored the cumulative incidence of patients becoming multi-switchers with >= 3 b/tsDMARDs stratified by calendar-period (2009-2011, 2012-2013, 2014-2015, 2016-2018). In the subgroup of patients starting a first b/tsDMARD 2009-2015, baseline characteristics associated with multi-switching (within 3 years' follow-up) were explored using multiple logistic regression analyses. Results Among 8398 patients included, 6056 patients (63% male, median age 42 years) started a first b/tsDMARD in 2009-2015, whereof proportions treated with >= 3, >= 4 or >= 5 b/tsDMARDs within 3 years' follow-up were 8%, 3% and 1%, respectively. Calendar-period did not affect the cumulative incidence of multi-switching. Baseline characteristics associated with multi-switching (>= 3 b/tsDMARDs) were female gender, shorter disease duration, higher patient global score, comorbidities and having psoriasis but not uveitis. Conclusion In this large Nordic observational cohort of axSpA patients, multiple switching was frequent with no apparent time-trend. Clinical associated factors included gender, but also previous comorbidities and extra-articular manifestations illustrating the ongoing challenge of treating this patient group.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Reumatologi och inflammation hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Rheumatology and Autoimmunity hsv//eng
biologic treatment
axial spondyloarthritis
routine care
registry
switching
necrosis-factor inhibitors
treatment response
psoriatic-arthritis
anterior uveitis
drug survival
routine care
therapy
fibromyalgia
danbio
predictors
Rheumatology

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Lindström, UlfGothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine, Department of Rheumatology and Inflammation Research(Swepub:gu)xlulfn (author)
Aaltonen, K. (author)
Relas, H. (author)
Provan, S. (author)
Gudbjornsson, B. (author)
Hetland, M. L. (author)
Askling, J.Karolinska Institutet (author)
Kauppi, M. (author)
Geirsson, A. J. (author)
Chatzidionysiou, K.Karolinska Institutet (author)
Jorgensen, T. S. (author)
Dreyer, L. (author)
Michelsen, B. (author)
Jacobsson, Lennart T. H.,1954Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine, Department of Rheumatology and Inflammation Research(Swepub:gu)xjacle (author)
Glintborg, B. (author)
Karolinska InstitutetInstitutionen för medicin, avdelningen för reumatologi och inflammationsforskning (creator_code:org_t)

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In:Rheumatology: Oxford University Press (OUP)61:9, s. 3647-36561462-03241462-0332

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By the author/editor: Di Giuseppe, D.; Lindström, Ulf; Aaltonen, K.; Relas, H.; Provan, S.; Gudbjornsson, B.; show more...; Hetland, M. L.; Askling, J.; Kauppi, M.; Geirsson, A. J.; Chatzidionysiou, ...; Jorgensen, T. S.; Dreyer, L.; Michelsen, B.; Jacobsson, Lenna ...; Glintborg, B.; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Rheumatology and ...

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By the university: University of Gothenburg; Karolinska Institutet

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