Nissen M.Delcoigne B.Di Giuseppe D.Jacobsson L.Hetland M.L.Ciurea A.Nekvindova L.Iannone F.Akkoc N.Sokka-Isler T.Fagerli K.M.Santos M.J.Codreanu C.Pombo-Suarez M.Rotar Z.Gudbjornsson B.Van Der Horst-Bruinsma I.Loft A.G.Moller B.Mann H.Conti F.Yildirim Cetin G.Relas H.Michelsen B.Avila Ribeiro P.Ionescu R.Sanchez-Piedra C.Tomsic M.Geirsson A.J.Askling J.Glintborg B.Lindstrom U.2024-07-222024-07-22202214620324http://akademikarsiv.cbu.edu.tr:4000/handle/123456789/12439Objectives: Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. Methods: Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP < 1.3 and/or BASDAI < 2) and stratified by treatment. Inter-registry heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Peripheral arthritis was defined as ≥1 swollen joint at baseline (=TNFi start). Results: Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P < 0.001). Remission was obtained in 20% on monotherapy and 22% on co-therapy (P < 0.001); adjusted OR of 1.16 (1.07, 1.25). Remission rates at 12 months were similar in patients with/without peripheral arthritis. Conclusion: This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy. © 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.EnglishAll Open Access; Green Open AccessAntirheumatic AgentsAxial SpondyloarthritisHumansSpondylarthritisTreatment OutcomeTumor Necrosis Factor InhibitorsTumor Necrosis Factor-alphaadalimumabcertolizumab pegoldisease modifying antirheumatic drugetanerceptgolimumabinfliximableflunomidemethotrexatesalazosulfapyridinetumor necrosis factor inhibitorantirheumatic agenttumor necrosis factortumor necrosis factor inhibitoradultAnkylosing Spondylitis Disease Activity ScoreArticleaxial spondyloarthritisBath ankylosing spondylitis disease activity indexcontrolled studydisease activity scoredisease durationdrug retentionfemalefollow uphumanjoint swellingmajor clinical studymalemonotherapyobservational studyoutcome assessmentremissiontreatment outcomespondylarthritisArticle10.1093/rheumatology/keac174