Background: Extra-articular manifestations (EAMs), such as uveitis, inflammatory bowel diseases (IBD), and psoriasis (PSO) can frequently complicate the disease course of patients with spondyloarthritis (SpA), although prevalence data on this regard are still controversial. The occurrence of EAMs may influence the decision to introduce a targeted therapy and also drive the choice of the most appropriate drug.

Objectives: The aim of this study is to retrospectively evaluate the prevalence of EAMs in a real-life cohort of SpA patients who were eligible to receive a targeted therapy and to investigate their impact in the choice of targeted treatment.

Methods: Clinical data of SpA (axial SpA [axSpA], peripheral SpA, and psoriatic arthritis [PsA]) patients treated with a biologic or targeted synthetic Disease-Modifying Anti-Rheumatic Drug (DMARD) between December 1999 and December 2019 were extracted from a local registry. Prevalence of main SpA-related EAMs (uveitis, IBD and PSO) was calculated at the time of drug prescription, evaluating their distribution according to treatment subgroups. Comparisons between disease and treatment subgroups were made using the Fisher’s test.

Results: The study included 629 patients with SpA (axSpA 26%, peripheral SpA 24%, PsA 50%), 266 [42%] women, mean age [±SD] 52 [±13.2] years, mean disease duration 7.8 [±7.9] years), receiving a total of 1106 lines of targeted treatment (I-line n=629, II-line n=258, ≥ III-line n=219) with etanercept (n=177), anti-TNF monoclonal antibodies (397 infliximab, 273 adalimumab, 38 certolizumab pegol, and 130 golimumab), secukinumab (n=46), ustekinumab (n=28), or apremilast (n=18). At the time of drug introduction, 13% of SpA patients showed at least one EAM. The prevalence of uveitis was higher in axSpA (11.8%) compared with both peripheral SpA (5.5%, p=0.01) and PsA (2.8%, p<0.0001), while IBD was more frequent in peripheral SpA (15.6%) than in axSpA (8.1%, p=0.008) and PsA (4.7%; p<0.0001). The prevalence of PSO was similar in axial and peripheral SpA (8.4 versus 6.3%, respectively; p=0.41). In the overall population, the baseline presence of at least one EAM was associated with a more frequent prescription of anti-TNF monoclonal antibodies rather than etanercept (14.4% versus 6.7%, respectively; p=0.004). Moreover, we observed a numerically, although not statistically significant, higher proportion of EAMs in patients treated with anti-TNF monoclonal antibodies rather than secukinumab (6.5%), ustekinumab (7.1%), and apremilast (5.9%).

Conclusion: In our real-life cohort of SpA patients treated with targeted therapies, EAMs were highly represented at baseline, especially uveitis in axSpA and IBD in peripheral SpA. The presence of extra-articular involvement was associated with a preferential prescription of anti-TNF monoclonal antibodies rather than etanercept or drugs with different mechanisms of action.

REFERENCES:

[1]Erol K, et al. Extra-articular manifestations and burden of disease in patients with radiographic and non-radiographic axial spondyloarthritis. Acta Reumatol Port. 2018;43(1):32-39.

[2]Molto A, Sieper J. Peripheral spondyloarthritis: Concept, diagnosis and treatment. Best Pract Res Clin Rheumatol. 2018;32(3):357-368.

[3]van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun;76(6):978-991.

Disclosure of Interests: Martina Biggioggero: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Antonio Marchesoni Speakers bureau: Abbvie, Pfizer, UCB, Novartis, Celgene, Eli Lilly, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB