OP0012 EFFECTIVENESS OF TNFI AFTER A FIRST SWITCH IS LOWER IN PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS: A LONGITUDINAL ANALYSIS OF THE DESIR COHORT

Background Some contradictory data has been reported on the effectiveness of a second and third line of TNFi in early axial spondyloarthritis (axSpA). Objectives To evaluate the effectiveness after a first and second TNFi switch, in real life conditions, over 5 years of follow-up in an early axSpa population. Methods Observational prospective French cohort (DESIR) with 5 years of follow-up, including 708 TNFi-naive early axSpA patients. Study visits were scheduled every 6 months in the first two years of follow up then yearly up to 5 years. Treatment (TNFi or other) was at the discretion of the treating rheumatologist’s. The characteristics of patients who received a second and a third TNFi were compared to those who never switched. Effectiveness was defined by the drug survival of the first, second and third TNFi were estimated by the Kaplan-Meier method, and compared using the log-rank test. Results Of the 708 patients included in the analysis, 258 (36.4%) patients initiated a first TNFi during the 5 years of follow up. Of these, 127/258 (49.2%) switched to a second TNFi, and among them 59/127(46.5%) switched to a third TNFi. Patients who switched to a second or a third TNFi were more frequently older, predominantly females, HLA-B27 negative, with MRI and radiographic sacroiliitis negative, without history of peripheral arthritis, and with higher BASFI and BASDAI scores at baseline of the DESIR cohort (see table). Estimated median drug survival for the first, second and third TNFi was 21.7 months [95%CI 17.6-33.6], 18.8 months [95%CI 15.1-24.4] and 25.0 months [95%CI 11.8-NA] respectively. Drug survival was significantly extended for the first TNFi compared to the second one (p=0.04), but no differences were observed between the 2nd and the 3rd TNFi. Conclusion Our study suggests a poorer TNFi effectiveness after a first switch in real-life conditions in early axial spondyloarthritis. Disclosure of Interests Marion Pons: None declared, Sylvie Chevret: None declared, Karine Briot Consultant for: Karine Briot has received consultancy honoraria and conference fees from UCB, Amgen, Lilly and MSD, Maria-Antonietta d’Agostino: None declared, Christian Roux Grant/research support from: Alexion, Amgen, UCB, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Anna Molto: None declared