0541: Treat-to-Target Strategy Implementation in Spondyloarthritis Patients of Real-World Clinical Practice: A Cross-Sectional Single-Center Study

Irini Flouri¹, Nestor Avgoustidis², Anastasios Eskitzis², Argyro Repa², Katerina Pateromichelaki², Sofia Pitsigavdaki³, Myrto Nikoloudaki², Maria Terizaki², George Bertsias⁴ and Prodromos Sidiropoulos⁴, ¹University of Crete Medical School, Heraklion, Greece, ²Rheumatology, Clinical Immunology and Allergy Department, Medical School, University of Crete, Heraklion, Greece, ³Rheumatology, Clinical Immunology and Allergy Department, Medical School, University of Crete, Crete, Greece, ⁴Rheumatology, Clinical Immunology and Allergy Department, Medical School, University of Crete, Greece; Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology Hellas (FORTH), Heraklion, Greece

Background/Purpose: Data regarding the adoption of the treat-to-target (T2T) approach aiming at inactive disease (ID), or low disease activity (LDA) in axial (axSpA) and peripheral Spondyloarthritis (perSpA) in real-world clinical practice is scarce. Our aims were to assess the level of disease activity of SpA patients in real-world practice, the extent of T2T strategy implementation and the reasons of possible non-implementation.

Methods: Cross-sectional study of all consecutive patients with SpA who visited the outpatient department or the one-day infusions’ clinic of our hospital during a 7-month period (6/2021-12/2021). Detailed patient, disease and treatment characteristics were collected, as well as disease activity of axial (using ASDAS-CRP), peripheral (DAPSA) and extraarticular manifestations. Additionally, physicians filled-in questionnaires regarding treatment intensification or not (and reasons) in patients not in target at the specific visit. Multivariable logistic regression analysis was employed to identify predictors of therapy intensifications in patients not in target.

Results: We analyzed243 patients (54% males; AxSpA:187, perSpA:56)with median (IQR) age of 52 (42-61) and disease duration 4.1 (2.1-12.3) years. The main therapy in the majority of the patients (83%) was a biologic (b-)DMARD.In patients with AxSpA, median (IQR) ASDAS-CRP was 2.4 (1.7-3.1), while in perSpA patients, median (IQR) DAPSA score was 26 (12.4-36.2). Low disease activity or inactive disease (LDA/ID), taking into account axial and/or peripheral as well as extraarticular manifestations was found in 26% and 25% of the patients in AxSpA and perSpA respectively.

Of the patients not having at least LDA (N=181), 82 (45%) had their treatment intensified. Physician-documented reasons of non-intensification are shown in Figure. In multivariable analysis, the type of patients’ main therapy [OR(95%CI) for non-bDMARD vs bDMARD:12.2 (4.8-41.4)], physician’s VAS score [OR:1.22 (1.10-1.27)]and patients’ VAS global score [OR:1.08 (1.02-1.12)]were predicting therapy intensifications in patients not in target.

Conclusion: In this real-world study, the majority of SpA patients had high disease activity levels. T2T strategy was implemented in approximately half of those patients, especially those on non-biologic main therapy and high physician VAS score.


I. Flouri: None; N. Avgoustidis: None; A. Eskitzis: None; A. Repa: None; K. Pateromichelaki: None; S. Pitsigavdaki: None; M. Nikoloudaki: None; M. Terizaki: None; G. Bertsias: None; P. Sidiropoulos: None.