AB0654 Survey of the Tolerance to the First Anti-TNF Therapy: Reasons for Discontinuation Including Loss of Efficacy and Adverse Effect of Different Anti-TNF Therapies (Data From Moscow Register)

Background Anti-TNF therapy has been proven highly effective in patients with spondyloarthritis, but about 30% of the patients developed secondary inefficacy or adverse effects (AE). Objectives Establishing the reasons and the frequency of discontinuation of different anti-TNF therapies in patients with axial SpA (axSpA) including ankylosing spondylitis (AS). Methods We reviewed 214 patients with axial SpA who were treated with the first anti-TNF therapy. The diagnoses were: ankylosing spondylitis -190 patients, nr-axSpA –25 patients. Clinical activity was measured by BASDAI at baseline before the 1st anti-TNF therapy. The 1st anti-TNF therapy was considered ineffective if BASDAI was >4.0 during 3 months and CRP or RSE were above normal. We considered discontinuation due to AE (psoriasis de novo, drug hepatitis, tuberculosis). Results Patients were treated with infliximab (n-156), adalimumab (n-24), etanercept (n-32), golimumab (n– 2). Mean age, male/female, duration disease were comparable. At baseline clinical activity was not different in patients of different groups. AE incident rates were similar (infliximab, adalimumab, etanercept), but pulmonary tuberculosis and conversion of PPD skin test were observed only in the infliximab group. Loss of efficacy was observed reliably more frequently in treatment with monoclonal antibodies. Discontinuations reasons Infliximab Adalimumab Etanercept p (n=156) (n=24) (n=32) Loss of the efficacy 32 (20.5%) 7 (29.2%) –