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. 2025 Jan 8;9(1):rkaf004.
doi: 10.1093/rap/rkaf004. eCollection 2025.

Impact of disease manifestations on first biologic drug survival in axial spondyloarthritis: a real-life Canadian study

Raphaël Hurtubise  1 , Sherry Rohekar  2 , Nigil Haroon  3 , Zeynep Baskurt  3 , Tina Chim  3 , Michel Zummer  1   4 , Robert D Inman  3 , Nicolas Richard  1   4   5 ; SpondyloArthritis Research Consortium of Canada (SPARCC)
Collaborators, Affiliations

Impact of disease manifestations on first biologic drug survival in axial spondyloarthritis: a real-life Canadian study

Raphaël Hurtubise et al. Rheumatol Adv Pract. .

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: ankylosing spondylitis; anti-TNF; axial spondyloarthritis; biological therapy; drug survival.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier biologic drug survival curves according to (A) acute anterior uveitis, (B) inflammatory bowel disease, (C) psoriasis, (D) nail psoriasis, (E) any EMM, (F) peripheral arthritis, (G) enthesitis, (H) dactylitis and (I) any peripheral musculoskeletal manifestation
Figure 2.
Figure 2.
Occurrence of treatment discontinuation over time in patients with psoriasis due to (A) lack of effectiveness and (B) side effects
Figure 3.
Figure 3.
Occurrence of treatment discontinuation over time in patients with dactylitis due to (A) lack of effectiveness and (B) side effects
See this image and copyright information in PMC

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