Evaluation of long-term TNFi effectiveness after a first switch in early axial spondyloarthritis considering time-varying prescription bias: an inverse-probability weighting analysis of the DESIR cohort

Marion Pons (1, 2) , Sylvie Chevret (2) , Karine Briot (1, 2) , Maria-Antonietta D’agostino (3) , Christian Roux (1, 2) , Maxime Dougados (1, 2) , Anna Molto (2, 4)

1 Hôpital Cochin [AP-HP]
2 ECaMO - [CRESS - U1153 / UMR_A 1125] - Clinical Epidemiology Applied to Osteoarticular Diseases | Épidémiologie clinique appliquée aux maladies rhumatismales et musculo-squelettiques
3 IRIS - Inflammation rhumatismale et système immunitaire
4 CRESS - U1153 - Equipe 4 : ECaMO - Épidémiologie clinique appliquée aux maladies rhumatismales et musculo-squelettiques

Objective To evaluate long-term effectiveness of tumour necrosis factor inhibitor (TNFi) after a first switch, and their associated factors in an early axial spondyloarthritis (axSpA) population, considering time-varying prescription bias. Methods Observational prospective cohort (DEvenir des Spondylarthropathies Indifférenciées Récentes) with 5 years of follow-up, including 708 TNFi-naïve patients with early axSpA. Long-term effectiveness of TNFi after a first switch (ASAS40 response after at least 2 visits under treatment) were estimated using marginal structural models (implementing inverse-probability weighting and iterative propensity scores). Factors associated with the outcome were explored by multivariate Cox regression models. Results The hazard to present an ASAS40 response after a first TNFi switch was increased (HR=2.4 (95% CI 1.9 to 3.0)); this response ratio was slightly lower compared with the response in TNFi naïve patients after a first TNFi (HR=3.3 (95% CI 2.9 to 3.8)). HLA-B27 positive was the only factor independently associated with ASAS40 response after a first TNFi switch. Conclusion After application of innovative methods to overcome time-varying prescription bias, the magnitude of the TNFi response after a first switch was found to be numerically lower but clinically relevant from the response in TNFi-naïve patients.

Domaines: Santé

Marion Pons, Sylvie Chevret, Karine Briot, Maria-Antonietta D’agostino, Christian Roux, et al.. Evaluation of long-term TNFi effectiveness after a first switch in early axial spondyloarthritis considering time-varying prescription bias: an inverse-probability weighting analysis of the DESIR cohort. RMD Open, 2022, 8 (1), pp.e001846. ⟨10.1136/rmdopen-2021-001846⟩. ⟨hal-04551395⟩