Ngo Minh-Duc, Zummer Michel, Andersen Kathleen M, Richard Nicolas
From the Faculty of Medicine, Université Laval, Québec, Canada.
Division of Rheumatology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
J Clin Rheumatol. 2022 Jan 1;28(1):e210-e216. doi: 10.1097/RHU.0000000000001693.
Data were obtained from persons enrolled in the SpondyloArthritis Research Consortium of Canada registry between 2003 and 2018. Kaplan-Meier curves were constructed from the time of biologic initiation until discontinuation and compared using the log-rank test. Subanalyses were performed according to calendar year and disease activity. Cox proportional hazards models were used to identify factors associated with discontinuation.
We identified 385 biologic-naive persons. Overall, the 349 AS participants had longer persistence to their first biologic than the 36 nr-axSpA subjects (p < 0.01). The Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index decreased by 2.3 points (95% confidence interval [CI], 1.9-2.7) and 3.2 points (95% CI, 2.6-3.7), respectively, in the first year and were stable thereafter. Adjusting for sex, human leukocyte antigen B27, and smoking status, nr-axSpA patients were more likely to discontinue their biologic than AS patients (hazards ratio, 1.65; 95% CI, 1.03-2.62).
In this real-world study, AS patients had longer persistence to their first biologic compared with nr-axSpA, with disease subtype being the most significant predictor of treatment persistence. Future studies should be targeted at assessing long-term clinical outcome of axSpA in the real-world setting.
数据来自于2003年至2018年期间纳入加拿大脊柱关节炎研究联盟登记处的人员。构建从开始使用生物制剂到停药的Kaplan-Meier曲线，并使用对数秩检验进行比较。根据日历年和疾病活动情况进行亚组分析。使用Cox比例风险模型确定与停药相关的因素。
我们确定了385名未使用过生物制剂的患者。总体而言，349名强直性脊柱炎（AS）参与者对其第一种生物制剂的持续使用时间长于36名非放射学中轴型脊柱关节炎（nr-axSpA）受试者（p<0.01）。在第一年，巴斯强直性脊柱炎疾病活动指数和巴斯强直性脊柱炎功能指数分别下降了2.3分（95%置信区间[CI]，1.9-2.7）和3.2分（95%CI，2.6-3.7），此后保持稳定。在对性别、人类白细胞抗原B27和吸烟状况进行校正后，nr-axSpA患者比AS患者更有可能停用生物制剂（风险比，1.65；95%CI，1.03-2.62）。
在这项真实世界研究中，与nr-axSpA相比，AS患者对其第一种生物制剂的持续使用时间更长，疾病亚型是治疗持续时间的最显著预测因素。未来的研究应针对评估真实世界环境中轴型脊柱关节炎的长期临床结局。
