Hurtubise Raphaël, Rohekar Sherry, Haroon Nigil, Baskurt Zeynep, Chim Tina, Zummer Michel, Inman Robert D, Richard Nicolas
Department of Medicine, Université de Montréal, Montreal, QC, Canada.
Division of Rheumatology, Department of Medicine, Western University, London, ON, Canada.
Rheumatol Adv Pract. 2025 Jan 8;9(1):rkaf004. doi: 10.1093/rap/rkaf004. eCollection 2025.
The primary objective of this study was to assess the impact of extramusculoskeletal manifestations (EMMs) and peripheral musculoskeletal features on first biologic drug survival in subjects with axial spondyloarthritis (axSpA). The secondary objective was to evaluate the impact of reasons for treatment discontinuation.
A total of 593 axSpA patients from the SpondyloArthritis Research Consortium of Canada initiating a first biologic drug were identified between 2003 and 2023. Drug survival was presented using Kaplan-Meier curves for each disease manifestation and compared using the logrank test. A Cox proportional hazards model was used to analyse independent predictors of discontinuation. The impact of reasons for treatment discontinuation was assessed using a competing risk analysis.
The presence of psoriasis, nail psoriasis, dactylitis, at least one EMM or at least one peripheral musculoskeletal manifestation was associated with prolonged drug survival compared with subjects without these disease manifestations. In multivariable analysis, psoriasis [hazard ratio (HR) 0.53 (95% CI 0.33, 0.86)] and at least one peripheral musculoskeletal manifestation [HR 0.65 (95% CI 0.47, 0.92)] were independently associated with a lower risk for biologic discontinuation. The presence of psoriasis or dactylitis was associated with reduced treatment discontinuation in patients who stopped their biologic medication for ineffectiveness but not when treatment was discontinued due to adverse events.
This study showed that the presence of some axSpA disease manifestations were associated with prolonged biologic drug survival. Psoriasis and peripheral musculoskeletal manifestations were the most significant predictors of treatment retention. Future research will be needed to further refine treatment strategies according to specific disease manifestations.
本研究的主要目的是评估轴性脊柱关节炎（axSpA）患者的肌肉骨骼外表现（EMM）和外周肌肉骨骼特征对首次使用生物制剂治疗的持续时间的影响。次要目的是评估治疗中断原因的影响。
在2003年至2023年期间，从加拿大脊柱关节炎研究联盟中确定了593例开始首次使用生物制剂的axSpA患者。使用Kaplan-Meier曲线展示每种疾病表现的药物持续时间，并使用对数秩检验进行比较。使用Cox比例风险模型分析中断治疗的独立预测因素。使用竞争风险分析评估治疗中断原因的影响。
与没有这些疾病表现的受试者相比，银屑病、指甲银屑病、指（趾）炎、至少一种EMM或至少一种外周肌肉骨骼表现的存在与延长的药物持续时间相关。在多变量分析中，银屑病[风险比（HR）0.53（95%置信区间0.33，0.86）]和至少一种外周肌肉骨骼表现[HR 0.65（95%置信区间0.47，0.92）]与生物制剂停药风险较低独立相关。银屑病或指（趾）炎的存在与因无效而停止生物制剂治疗的患者治疗中断减少有关，但因不良事件而停药时则不然。
本研究表明，某些axSpA疾病表现的存在与生物制剂治疗持续时间延长相关。银屑病和外周肌肉骨骼表现是治疗持续的最重要预测因素。未来需要进一步研究根据特定疾病表现优化治疗策略。
