Impact of clinical subtype and sex on first-line biologic therapy discontinuation in axial spondyloarthritis.

IF 20.3 1区医学 Q1 RHEUMATOLOGY

Annals of the Rheumatic Diseases Pub Date : 2025-02-06 DOI:10.1016/j.ard.2025.01.007

Patricia Remalante-Rayco, Emmanuel S Baja, Zeynep Baskurt, Tina Chim, Carlo Irwin A Panelo, Evelyn Osio-Salido, Robert D Inman, Leonila F Dans, Nigil Haroon

{"title":"Impact of clinical subtype and sex on first-line biologic therapy discontinuation in axial spondyloarthritis.","authors":"Patricia Remalante-Rayco, Emmanuel S Baja, Zeynep Baskurt, Tina Chim, Carlo Irwin A Panelo, Evelyn Osio-Salido, Robert D Inman, Leonila F Dans, Nigil Haroon","doi":"10.1016/j.ard.2025.01.007","DOIUrl":null,"url":null,"abstract":"Objectives: To estimate the main and interaction effects of axial spondyloarthritis (axSpA) subtype and sex on first biologic disease-modifying antirheumatic drug (bDMARD) discontinuation.Methods: This retrospective cohort study included nonradiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA) patients initiating tumour necrosis factor or interleukin-17 inhibitors. Modified Poisson regressions were used to estimate risk ratios (RRs) for the association of subtype and sex with discontinuation, adjusting for baseline covariates. Interaction was assessed using the relative excess risk due to interaction (RERI) and ratio of RRs. In addition, bDMARD survival rates were analysed using Kaplan-Meier curves.Results: Among 469 patients, 64% discontinued their first bDMARD. Nr-axSpA (RR, 1.80; 95% CI, 1.26-2.59) and female sex (RR, 1.49; 95% CI, 1.081-2.045) were significantly associated with discontinuation. Positive interaction trends between subtype and sex were observed on additive (RERI 0.49, 95% CI, -0.78 to 1.75) and multiplicative (RR ratio, 1.05; 95% CI, 0.55-2.03) scales, though not statistically significant. Nr-axSpA females had twice the discontinuation risk of r-axSpA males (hazard ratio, 2.30; 95% CI, 1.68-3.15, P < .001). bDMARD survival over 20 years was significantly lower in nr-axSpA and female patients.Conclusions: Nr-axSpA and female patients face a significantly higher risk of bDMARD discontinuation and shorter bDMARD survival. Although the combined effect of subtype and sex trended higher, it was not statistically significant. These findings underscore the need to address potential treatment challenges in female nr-axSpA patients.","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3000,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the Rheumatic Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ard.2025.01.007","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: To estimate the main and interaction effects of axial spondyloarthritis (axSpA) subtype and sex on first biologic disease-modifying antirheumatic drug (bDMARD) discontinuation.

Methods: This retrospective cohort study included nonradiographic axSpA (nr-axSpA) and radiographic axSpA (r-axSpA) patients initiating tumour necrosis factor or interleukin-17 inhibitors. Modified Poisson regressions were used to estimate risk ratios (RRs) for the association of subtype and sex with discontinuation, adjusting for baseline covariates. Interaction was assessed using the relative excess risk due to interaction (RERI) and ratio of RRs. In addition, bDMARD survival rates were analysed using Kaplan-Meier curves.

Results: Among 469 patients, 64% discontinued their first bDMARD. Nr-axSpA (RR, 1.80; 95% CI, 1.26-2.59) and female sex (RR, 1.49; 95% CI, 1.081-2.045) were significantly associated with discontinuation. Positive interaction trends between subtype and sex were observed on additive (RERI 0.49, 95% CI, -0.78 to 1.75) and multiplicative (RR ratio, 1.05; 95% CI, 0.55-2.03) scales, though not statistically significant. Nr-axSpA females had twice the discontinuation risk of r-axSpA males (hazard ratio, 2.30; 95% CI, 1.68-3.15, P < .001). bDMARD survival over 20 years was significantly lower in nr-axSpA and female patients.

Conclusions: Nr-axSpA and female patients face a significantly higher risk of bDMARD discontinuation and shorter bDMARD survival. Although the combined effect of subtype and sex trended higher, it was not statistically significant. These findings underscore the need to address potential treatment challenges in female nr-axSpA patients.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of the Rheumatic Diseases 医学-风湿病学

CiteScore

35.00

自引率

9.90%

发文量

3728

审稿时长

1.4 months

期刊介绍： Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.