(040) Persistence Associated With The Use Of Biologicals For The Treatment Of Ankylosing Spondylitis In The Brazilian Public Health System

Publication Number: 377

Background: Ankylosing spondylitis (AS) is the main subtype of spondyloarthritis and preferentially affects the axial skeleton. AS affects adults and young people, with a peak incidence in men between 20 and 30 years of age. In the Brazilian public health system, the biological anti-TNF DMARDs adalimumab, etanercept, infliximab, golimumab and certolizumab and the anti-IL17A secukinumab are available for the treatment of AS. However, non-adherence to treatment can result in disease progression. In view of this, treatment persistence can be considered a way of accurately assessing effectiveness, comprising safety, efficacy, and usefulness in real life for rheumatic diseases.

Objectives: To evaluate the therapeutic persistence and effectiveness of biological DMARDs listed for the treatment of AS in the Brazilian public health system.

Methods: 456 individuals diagnosed with AS were followed. Data were collected from 2018 to 2021, based on information from medical processes requesting the use of biological DMARDs in the state of Minas Gerais, Brazil. Demographic, clinical and laboratory data, scores from tools for measuring disease activity such as ASAS and BASDAI were collected. Factors associated with persistence was evaluated using the logistic regression model and Kaplan-Meier.

Results: Of the individuals followed up, 93.9% had sacroilitis and 73.2% were positive for the HLA-B27 antigen. Adalimumab was prescribed to 91.0% of individuals as the first line of treatment with biological DMARDs, while certolizumab was the anti-TNF with the lowest frequency of prescription (0.7%). Forty subjects discontinued treatment and 75 changed therapy. Individuals using infliximab had a higher incidence on switching treatments, while individuals using certolizumab had a higher discontinuity (33.3%). In the multivariate analysis, persistence was statistically significant in the age group of 50-59 years OR 0.38 (95%CI 0.17-0.89; p=0.026), individuals with spinal movement limitations lumbar OR 2.39 (95% CI 1.21-4.72; p=0.012), use of adalimumab and infliximab OR 5.17 (95% CI 2.33-11.48; p< 0.001) and 0 .15 (95% CI 0.020-0.99; p=0.050) respectively.

Conclusions: In general, biological DMARDs have been shown to be effective for the treatment of AS. When evaluating the effectiveness profile through treatment persistence, it is observed that approximately 60% of individuals using adalimumab continued with the treatment until the 25th month, information that can be reinforced through univariate and multivariate analysis, demonstrating that the medication is strongly associated with persistence in treatment, consequently being more effective.