Griffiths Hedley, Smith Tegan, Mack Christopher, Leadbetter Jo, Butcher Belinda, Acar Mustafa, Ciciriello Sabina
H. Griffiths, MBBS, FRACP, OPAL Rheumatology Ltd, Sydney, and Barwon Rheumatology Service, Geelong;
T. Smith, PhD, OPAL Rheumatology Ltd, Sydney.
J Rheumatol. 2022 Feb;49(2):150-156. doi: 10.3899/jrheum.201551. Epub 2021 Aug 1.
To describe the treatment response and persistence to biologic disease-modifying antirheumatic drug (bDMARD) therapy in patients with ankylosing spondylitis (AS) in a real-world Australian cohort.
This was a retrospective, noninterventional cohort study that extracted data for patients with AS from the Optimising Patient outcomes in Australian RheumatoLogy (OPAL) dataset for the period of August 2006 to September 2019. Patients were classified as either bDMARD initiators if they commenced a bDMARD during the sampling window, or bDMARD-naïve if they did not. Results were summarized descriptively. Treatment persistence was calculated using Kaplan-Meier methods. Differences in treatment persistence were explored using log-rank tests.
There were 5048 patients with AS identified. Of these, 2597 patients initiated bDMARDs and 2451 remained bDMARD-naïve throughout the study window. Treatment with first-, second-, and third-line bDMARDs significantly reduced disease activity. Median persistence on first-line bDMARDs was 96 months (95% CI 85-109), declining to 19 months (95% CI 16-22) in second-line therapy, and 15 months (95% CI 11-18) in third-line therapy. Median persistence was longest for the golimumab (GOL) group in all lines of therapy and shortest for the etanercept (ETN) group. Differences in persistence rates according to the time period that bDMARDs were prescribed (pre- and post-2012) were also seen for ETN and adalimumab.
In this cohort, all bDMARDs effectively reduced AS disease activity. Treatment persistence was sustained for up to 8 years for patients remaining on their first bDMARD, longer than on subsequent agents. Further research is needed to determine its influence on treatment recommendations.
描述澳大利亚一个真实世界队列中强直性脊柱炎（AS）患者对生物改善病情抗风湿药物（bDMARD）治疗的反应及持续情况。
这是一项回顾性、非干预性队列研究，从2006年8月至2019年9月澳大利亚风湿病优化患者结局（OPAL）数据集中提取AS患者的数据。如果患者在抽样窗口期间开始使用bDMARD，则分类为bDMARD起始者；如果未使用，则分类为未使用过bDMARD者。结果进行描述性总结。使用Kaplan-Meier方法计算治疗持续时间。使用对数秩检验探索治疗持续时间的差异。
共识别出5048例AS患者。其中，2597例患者开始使用bDMARD，2451例在整个研究窗口期间未使用过bDMARD。一线、二线和三线bDMARD治疗均显著降低疾病活动度。一线bDMARD的中位持续时间为96个月（95%CI 85-109），二线治疗降至19个月（95%CI 16-22），三线治疗为15个月（95%CI 11-18）。在所有治疗线中，戈利木单抗（GOL）组的中位持续时间最长，依那西普（ETN）组最短。ETN和阿达木单抗在根据bDMARD处方时间（2012年前和2012年后）的持续率差异也有体现。
在这个队列中，所有bDMARD均有效降低AS疾病活动度。继续使用首个bDMARD的患者治疗持续时间长达8年，长于后续药物。需要进一步研究以确定其对治疗建议的影响。
