ArticleEULAR rheumatology open2025
Which are the clinical characteristics that lead to the decision of primary or secondary usage of TNFi or IL-17i in patients with axial spondyloarthritis?: Real-world evidence from the RABBIT-SpA cohort.
Article in EULAR rheumatology open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Assessment of Spondyloarthritis International Society (ASAS)-EULAR treatment recommendations for axial spondyloarthritis (axSpA) suggest advanced therapies after failure of nonsteroidal anti-inflammatory drugs. However, there is insufficient evidence about the best treatment sequence. The primary objective of this study was to analyse the choice of first-/second-line biological disease-modifying antirheumatic drug (bDMARD) treatment as prescribed in routine rheumatology care and to compare patient and disease characteristics at the beginning of first/second bDMARD. Methods: bDMARD-naïve patients from the prospective German RABBIT-SpA registry initiating their first tumour necrosis factor inhibitor (TNFi) or interleukin-17i (IL-17i) were eligible. Characteristics at beginning of first-/second-line therapy were compared between the 2 groups. Results: First line: 848 of 1006 patients were treated with TNFi; 158 with IL-17i. Significant differences were found in regard to extramusculoskeletal manifestations (EMMs): psoriasis/uveitis/inflammatory bowel disease (IBD) in 14%/10%/none of IL-17i compared with 7%/14%/5% of TNFi patients. Disease activity, joint count (JC), and patient-reported outcomes were not statistically significant different. Second line: in 289 patients (of those 248 with TNFi, 41 with IL-17i first line), second-line data were available. Of the 248 TNFi first-line patients, 179 (76%) cycled to a second TNFi, whereas 58 (25%) switched to IL-17i. Switchers had significantly higher JC and enthesitis counts. Axial Spondyloarthritis Disease Activity Score did not differ. Significant differences were again found in EMMs: psoriasis/uveitis/IBD in 16%/7%/5% of IL-17i compared with 9%/13%/9% of TNFi patients. Cycler experienced more often secondary failure, switcher more often primary failure in their first-line TNFi. Conclusions: As recommended in ASAS-EULAR recommendations, EMMs in particular are taken into account in routine care for the treatment decision in first-/second-line bDMARD.
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