Association of the Driving Distance, Driving Time, and Public Transit Time to the Hospital with the Persistence of Tumor Necrosis Factor Inhibitors in Patients With Ankylosing Spondylitis: A Retrospective Cohort Study.

Purpose: Research on the impact of geographical distance from or travel time to healthcare facilities on treatment adherence among patients with rheumatic diseases is lacking. Therefore, we investigated the association of the driving distance, driving time, and public transit time to the hospital with the persistence of tumor necrosis factor-alpha (TNF-α) inhibitors in patients with ankylosing spondylitis (AS).

Patients and methods: This 19-year retrospective cohort study was performed in the rheumatology department of a tertiary hospital in Korea and analyzed 313 adult patients with AS who were newly initiated on TNF-α inhibitors. The driving distance, driving time, and public transit time to the hospital were calculated using the Naver Map application. Drug persistence of TNF-α inhibitors was defined as the time duration between the index date and the date of discontinuation without exceeding a treatment gap of 90 days.

Results: The most commonly prescribed TNF-α inhibitor in patients with AS was adalimumab (69.3%), followed by etanercept (21.4%) and infliximab (9.3%). The median driving distance, driving time, and public transit time to the hospital were 16 kilometers (km), 0.6 hours, and 0.8 hours, respectively. In total, 120 (38.3%) patients with AS stopped TNF-α inhibitors over a median follow-up period of 67.1 months. After adjusting confounding factors, the driving distance to the hospital per 10-km increase (hazard ratio [HR]=1.09, p=0.017) and the driving distance to hospital ≧16 km (HR=1.9, p=0.001) were significantly associated with a higher risk of TNF-α inhibitor discontinuation. Neither the driving time nor the public transit time to the hospital was significantly associated with TNF-α inhibitor persistence.

Conclusion: Longer driving distances significantly increased the risk of treatment discontinuation, highlighting the need for healthcare systems to address these barriers.