The occurrence of multiple treatment switches in axial spondyloarthritis. Results from five Nordic rheumatology registries.

• Published in: Rheumatology
• Main Authors: Di Giuseppe, Daniela, Lindström, Ulf, Aaltonen, Kalle, Relas, Heikki, Provan, Sella, Gudbjornsson, Bjorn, Hetland, Merete Lund, Askling, Johan, Kauppi, Markku, Geirsson, Arni Jon, Chatzidionysiou, Katerina, Jørgensen, Tanja Schjødt, Dreyer, Lene, Michelsen, Brigitte, Jacobsson, Lennart, Glintborg, Bente
• Other Authors: 1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 3Ministry of Social Affairs and Health, Pharmaceuticals Pricing Board, Helsinki, Finland. 4Departments of Medicine and Rheumatology, Helsinki University Hospital (ROB-FIN), Helsinki, Finland. 5Diakonhjemmet Hospital, Oslo, Norway. 6Centre for Rheumatology Research (ICEBIO), Landspitali University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 7Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 8DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark. 9Clinical Epidemiology Division, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 10Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland. 11Department of Rheumatology, University Hospital, Reykjavik, Iceland. 12The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark. 13Department of Rheumatology, Aalborg University Hospital, Denmark. 14Department of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway. 15Division of Rheumatology, Department of Medicine, Sørlandet Sykehus, Kristiansand, Norway. 16DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Copenhagen, Denmark.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Oxford University Press 2022
• Subjects: Biological treatment; axial spondyloarthritis; registry; routine care; switching; Hryggikt; Gigtarsjúkdómar; Norway; Iceland
• Online Access: http://hdl.handle.net/2336/622097; https://doi.org/10.1093/rheumatology/keab946

To access publisher's full text version of this article click on the hyperlink below Objectives: In axial spondyloarthritis (axSpA), switching between multiple biologic or targeted synthetic (b/ts-) DMARDs might indicate difficult-to-treat disease. We aimed to explore the occurrence of multiple switching in routine care axSpA patients using various definitions, and to identify associated clinical characteristics upon start of first b/tsDMARD (baseline). Methods: Observational cohort study including patients with axSpA starting a first-ever b/tsDMARD 2009-2018 based on data from five biologic registries (Denmark/Sweden/Finland/Norway/Iceland). Comorbidities and extra-articular manifestations were identified through linkage to national registries. Multi-switching was defined in overlapping categories according to b/tsDMARD treatment history: treatment with ≥3 b/tsDMARDs, ≥4 or ≥ 5 b/tsDMARDs during follow-up. We explored the cumulative incidence of patients becoming multi-switchers with ≥3 b/tsDMARDs stratified by calendar-period (2009-11/2012-13/2014-15/2016-2018). In the subgroup of patients starting a first b/tsDMARD 2009-2015, baseline characteristics associated with multi-switching (within 3 years' follow-up) were explored using multiple logistic regression analyses. Results: Among 8,398 patients included, 6,056 patients (63% male, median age 42 years) started a first b/tsDMARD 2009-2015, whereof proportions treated with ≥3, ≥4 or ≥ 5 b/tsDMARDs within 3 years' follow-up were 8%, 3%, 1%, respectively.Calendar-period did not affect the cumulative incidence of multi-switching.Baseline characteristics associated with multi-switching (≥3 b/tsDMARDs) were female gender, shorter disease duration, higher patient global score, comorbidities, and having psoriasis but not uveitis. Conclusion: In this large Nordic observational cohort of axSpA patients, multiple switching was frequent with no apparent time-trend. Clinical associated factors included gender, but also previous comorbidities and extraarticular ...