Symptoms and comorbidities of ankylosing spondylitis (AS) considerably reduce health-related quality of life (HRQoL) and ability to work. This real-world study assessed rates of tumour necrosis factor inhibitor (TNFi) use and switching, treatment failure, and associations between failing TNFi and HRQoL, work productivity and activity impairment (WPAI). AS patients and their treating physicians completed questionnaires capturing patient demographics, clinical status, TNFi treatment history, reasons for switching TNFi, HRQoL and WPAI. Current TNFi was determined as “failing” if, after ≥3 months, physician-rated disease severity had worsened, remained severe, was “unstable/deteriorating”, physicians were dissatisfied with disease control and/or did not consider treatment a “success”. The analysis included 2866 AS patients from 18 countries. Of 2795 patients with complete treatment data, 916 (32.8%) patients had never received TNFi therapy, 1623 (58.1%) patients were receiving their 1st TNFi and 200 (7.2%) patients had ever received ≥2 TNFi (treatment switch). Primary or secondary lack of efficacy were the commonest reasons for switching, and the mean delay in switching after primary lack of efficacy was 11.1 months. 232 (15.4%) patients on TNFi were currently “failing” who, compared to those with treatment success, reported poorer HRQoL: 5-dimension EuroQoL (EQ-5D-3 L): 0.63 vs. 0.78; Medical Outcomes Study Short-Form Health Survey version 2 (SF-36v2) mental component summary (MCS): 41.8 vs. 46.3; physical component summary (PCS): 40.2 vs. 45.1; impaired work productivity: 46.4% vs. 25.0%; and activity: 44.5% vs. 29.6%; all P < 0.001. Among AS patients, switching TNFi is uncommon and delayed by nearly 1 year despite primary lack of efficacy. Patients currently failing TNFi experience worse physical function, HRQoL and work productivity.

中文翻译：

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接受肿瘤坏死因子抑制剂治疗的强直性脊柱炎患者未满足的需求；来自大型跨国现实世界研究的结果

强直性脊柱炎 (AS) 的症状和合并症会大大降低与健康相关的生活质量 (HRQoL) 和工作能力。这项真实世界的研究评估了肿瘤坏死因子抑制剂 (TNFi) 的使用和转换率、治疗失败率，以及失败的 TNFi 与 HRQoL、工作效率和活动障碍 (WPAI) 之间的关联。AS 患者及其治疗医师完成了问卷调查，其中包括患者人口统计数据、临床状态、TNFi 治疗史、转换 TNFi 的原因、HRQoL 和 WPAI。如果 ≥ 3 个月后，如果医生评定的疾病严重程度恶化、仍然严重、“不稳定/恶化”、医生对疾病控制不满意和/或不认为治疗“成功”，则当前 TNFi 被确定为“失败” . 该分析包括来自 18 个国家的 2866 名 AS 患者。在 2795 名具有完整治疗数据的患者中，916 名（32.8%）患者从未接受过 TNFi 治疗，1623 名（58.1%）患者正在接受第一次 TNFi 治疗，200 名（7.2%）患者曾接受过≥2 次 TNFi（治疗转换）。原发性或继发性无效是转换的最常见原因，原发性无效后转换的平均延迟为 11.1 个月。232 名 (15.4%) 使用 TNFi 的患者目前“失败”，与治疗成功的患者相比，他们报告的 HRQoL 较差：5 维 EuroQoL (EQ-5D-3 L)：0.63 对 0.78；医疗结果研究简表健康调查第 2 版 (SF-36v2) 心理成分总结 (MCS)：41.8 与 46.3；物理组件摘要 (PCS)：40.2 与 45.1；工作效率受损：46.4% 对 25.0%；和活动：44.5% 对 29.6%；所有 P < 0.001。在 AS 患者中，尽管最初缺乏疗效，但转换 TNFi 并不常见，并且延迟了近 1 年。目前 TNFi 失败的患者身体功能、HRQoL 和工作效率都较差。