AB0375 IN PATIENTS STARTING ETANERCEPT, MALE SEX, ABSENCE OF COMORBIDITIES AND NO csDMARDs CO-ADMINISTRATION ARE INDEPENDENT PREDICTORS OF LONG-TERM (MORE THAN 3 YEARS) PERSISTENCE TO THERAPY, IRRESPECTIVELY OF THE CLINICAL DIAGNOSIS.

Abstract

BackgroundComparative data among rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA) patients regarding long-term survival of etanercept (ETN) in clinical practice are limited.ObjectivesThe first aim of this study was to analyze the long-term (>3 years) ETN survival comparatively between its three main indications. We also aimed to analyze for predictors of long term ETN survival.MethodsWe analyzed data from the University of Crete Rheumatology Clinic Registry (UCRCR), a single center prospective cohort study. All patients with a diagnosis of RA, SpA or PsA starting treatment with a biologic DMARD are recorded prospectively based on a common follow-up protocol. For the first aim, ETN survival >3 years was compared among the 3 diseases. For the 2nd aim patients on ETN >3 years were compared to those stopping ETN during the first 2 years. We analyzed baseline and early on treatment (first 6 months) characteristics, comedications, comorbidities as predictors for long term survival applying univariate and multivariate models.ResultsA total of 711 patients who were started on ETN were analyzed (RA: 450, SpA: 177, PsA: 84). As expected, patients’ and disease characteristics at baseline differed significantly between the 3 diagnoses (Table 1). Patients’ function was compromised irrespective of the diagnosis, while inflammatory activity was significant across diseases.Table 1.Baseline parameters [Medians (IQR) unless otherwise specified]RA (n=450)SpA (n=177)PsA (n=84)pWomen N (%)370 (82)66 (37)46 (55)<0.001Age61.5 (53-70)44.5 (35-54)51 (41-62)<0.001Disease duration2.6 (0.9-6.5)0.8 (0.1-5.1)1.7 (0.6-4.9)<0.001Follow-up years1.0 (0.5-2.1)1.0 (0.4-3.1)1.1 (0.4-3.6)0.649Total comorbidities nr.3 (1-4)1 (0-3)2 (1-4)<0.001RDCI1 (1-2)0 (0-1)1 (0-1)<0.001Ever smokers N(%)124 (39)82 (67)30 (61)<0.001BMI31 (26-35)27 (25-32)29 (23-32)0.015Treatment line N (%): 1st264 (59)87 (49)43 (51)0.012 2nd119 (26)70 (39.5)24 (29) ≥ 3rd67 (15)20 (11)17 (20)Nr of previous csDMARDs2 (1-3)1 (0-2)1 (1-2)<0.001Co-administered MTX N(%)284 (63)65 (37)50 (60)<0.001Monotherapy, N (%)60 (13)100 (56.5)25 (30)<0.001Ongoing corticosteroids N(%)153 (34)25 (14)17 (20)<0.001DAS28 - ESR5.8 (5.0-6.5)3.7 (2.9-4.7)5.3 (4.5-6.4)<0.001ASDAS-ESR-3.4 (2.8-4.1)3.6 (3.2-4.7)0.067CRP (mg/dl)0.4 (0.3-1.1)1.1 (0.3-2.4)0.8 (0.4-2.0)<0.001During a follow-up of 1371 patient-years, 466 (65.5%) patients stopped therapy. The estimated percentage of patients persisting on ETN therapy for > 3 years was 28.4%, 42.8% and 44% of RA, SpA and PsA respectively. The main reason for therapy discontinuation was inefficacy (75% of stop reasons in RA vs. 58% in SpA vs. 69% in PsA).In multivariable Cox regression analyses the most important predictor for ETN survival was the achievement of LDA/remission at 6 months based on DAS28 for RA or ASDAS for SpA [Odds Ratio (OR) 1.98, p=0.008 and 3.02, p=0.001 respectively]. Prognostic factors for ETN discontinuation specifically due to inefficacy were comorbidities number and csDMARDs coadministration (p<0.05 for both), while older age and no co-therapy with MTX predicted ETN stop due to adverse events (p<0.05 for both).Logistic regression analysis indicated that male sex [OR: 2.08, p=0.004], calendar year of treatment start [OR per 3 years: 0.74, p=0.001], comorbidities’ number [OR: 0.82, p=0.045] and monotherapy [OR: 1.81, p=0.027] predict persistence on ETN therapy beyond 3 years, while the clinical diagnosis or other baseline parameters are not significant predictors.ConclusionIn this prospective cohort study, we found that ETN survival was higher for patients with SpA/PsA as compared to RA. Male sex, absence of comorbidities and no csDMARDs co-administration are independent predictors of long-term persistence to therapy, irrespectively of the clinical diagnosis. Notably, both in RA and SpA, 6-month response predicted ETN survival in the long term.AcknowledgementsThis study was funded by the Pancretan Health Association and Pfizer Global Medical Grants.Disclosure of InterestsNone declared