AB0475\u2005COMPARATIVE EFFECTIVENESS OF BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN REAL CLINICAL PRACTICE ACCORDING TO THE MOSCOW UNIFIED ARTHRITIS REGISTER (MUAR)

Abstract

This study is the first analysis of biological disease-modifying antirheumatic drugs (bDMARDs) for ankylosing spondylitis (AS) within the Moscow Unified Arthritis Register (MUAR).to compare the effectiveness of bDMARDs in patients with AS using data from the MUAR.The analysis included the data of patients with AS who were included in the MUAR and received biological therapy for at least 6 months. The effectiveness of the drugs was assessed by the achieved values of the indices of diseases activity and its manifestations: ASDAS(C-RP), BASDAI, LEI, MASES, indicators of the functional ability of patients (BASFI, HAQ) at the last completed visit. Comparison of indicators between drugs was in a general linear model, adjusted for the identified confounders. The search for confounders was in 2 stages: first, by univariate analysis, were identified indicators significantly related to the achieved ASDAS. Then, within the multivariate general linear model, by backward stepwise selection were determinate variables significantly and independently associated with ASDAS.The current study included 363 episodes of treatment with bDMARDs in 361 patients. There were 240 men (66.5%). The average age of the included patients was 46.3 ± 11.2, the age at the onset of the disease was 27.3 ± 11.4. The average duration of a treatment episode until the patient was assessed 1135 ± 900 days. Significant differences of the values of ASDAS(p = 0.033) and ESR (p = 0.007) between bDMARDs were revealed. In pairwise comparisons of the achieved ASDAS using the Shidak adjustment, demonstrated that the values on infliximab and adalimumab were significantly lower than on certolizumab pegol (p = 0.009 and p = 0.041, respectively). Also significantly higher ESR values on certolizumab compared to all other drugs (p < 0.001 for all) were found. There were no statistically significant differences between the drugs for other studied parameters.The studied bDMARDs (infliximab, adalimumab, etanercept, certolizumab pegol, golimumab, secukinumab) demonstrate generally similar clinical efficacy in real clinical practice. The effect of golimumab and sekukinumab which have been recently introduced into clinical practice doesn’t differ significantly from the effect of TNF inhibitors which has been used for a long time.Table 1.Achieved values of the indices of activity and functional ability against the background of treatment with bDMARDs.ASDAS(С-RP)BASDAIHAQBASFIunadjustedadjustedunadjustedadjustedunadjustedadjustedunadjustedadjustedADA1,89 ±0,891,54 ± 0,293,07 ± 1,612,89 ± 0,250,63 ± 0,420,60 ± 0,073,25 ± 2,023,09 ± 0,32GOL2,08 ± 0,992,22 ± 0,313,09 ± 1,963,44 ± 0,490,66 ± 0,610,78 ± 0,143,74 ± 2,934,00 ± 0,63INF1,57 ± 0,821,29 ± 0,322,64 ± 1,552,19 ± 0,380,56 ± 0,520,57 ± 0,112,81 ± 2,292,93 ± 0,49ETA1,96 ± 0,851,94 ± 0,243,19 ± 1,693,44 ± 0,190,65 ± 0,530,72 ± 0,063,39 ± 2, 263,88 ± 0,24CER2,69 ± 1,032,95 ± 0,464,07 ± 2,283,65 ± 0,521,12 ± 0,820,84 ± 0,155,07 ± 2,954,19 ± 0,67SEK2,69 ± 1,311,66 ± 0,513,72 ± 2,223,71 ± 0,490,85 ± 0,470,85 ± 0,143,46 ± 2,133,46 ± 0,63ADA – Adalimumab, GOL – Golimumab, INF – Infliximab, ETA – Etanercept, CER – Certolizumab pegol, SEK – Sekukinumab, ASDAS - Ankylosing Spondylitis Disease Activity Score, BASDAI Bath Ankylosing Spondylitis Disease Activity Index, BASFI - Bath Ankylosing Spondylitis Functional Index, HAQ - Health Assessment Questioner, C-RP – C-reactive protein.None declared.