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AB0706 DIFFERENCES IN RHEUMATOLOGISTS’ TREATMENT PREFERENCES FOR ANKYLOSING SPONDYLITIS AND NON- RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background: The lack of a formal indication for Non-Radiographic axial Spondyloarthritis (nr-axSpA) has meant that many US rheumatologists fundamentally treat it as an early manifestation of ankylosing Spondylitis (AS) and seldom differentiate their treatment approach when using biologics/small molecules. Objectives: This study sought to gain a better understanding of the number of aS and nr-axSpA patients rheumatologists manage, recent changes made in treatment, and how aS and nr-axSpa patients are differentiated beyond radiographic evidence. The study also evaluated the differences in use of biologics/small molecules for the treatment of aS and nr-axSpA and rheumatologist projected changes in the management of these two conditions. Methods: An independent market analytics firm administered a survey with US rheumatologists (n=104) on the treatment landscape for aS and nr-axSpA. To qualify, rheumatologists had to spend the majority of their professional time in clinical practice, manage a minimum of 50 aS or nr-axSpA patients, and have been in practice between 2 and 35 years. Respondents answered questions pertaining to their practice, the demographics of their aS/nr-axSpA patients, their treatment approaches for each type, as well as attitudinal statements. The survey was administered online in February 2018 and respondents were compensated for their participation. A similar study was also conducted in 2017 allowing for year over year comparison. The data were collected and analyzed in SPSS. Results: Three-quarters of rheumatologists reported they treated their aS and nr-axSpA patients in a similar manner, though there was a higher use of NSAIDs and local steroids in non-radiographic disease, and more biologic/JAK use in aS. More established TNF inhibitors such as adalimumab, etanercept, and infliximab dominated biologics/small molecule preference, collectively accounting for approximately three-quarters of all biologic-treated aS and nr-axSpA patients. However, use of adalimumab, etanercept, and infliximab was expected to decline or stay flat in the next three months, while use of secukinumab, tofacitinib, golimumab IV, and both infliximab biosimilars, was anticipated to increase. Although not indicated for either condition, 28% of respondents reported off-label use of tofacitinib for aS, and 25% for nr-axSpA, a significant increase from 2017. Projected off-label use of tofacitinib in the following three months is also expected to increase. Conclusion: Rheumatologists are less likely to use biologics/small molecules for nr-axSpA, but when they do, use of brands is similar to those used in aS. While TNF inhibitors continue to account for the majority of biologic/small molecule prescriptions for these conditions, rheumatologists project increased use of agents with alternative mechanisms of action in the future. Disclosure of interests: None declared