OBJECTIVES: Axial spondyloarthritis (axSpA) treatment options, including biologic disease-modifying anti‑rheumatic drugs (bDMARDs), e.g., TNF and IL-17A inhibitors, have increased in number. Examining real-world treatment patterns is important for patients and healthcare providers. The objective was to reveal axSpA patient characteristics, including comorbidities and bDMARD-history, in relation to bDMARD-initiation and dosing in real-world clinical practice.

METHODS: This study utilized German AOK Plus claims data. Adult patients with axSpA with a newly initiated bDMARD treatment between 2018–2021 were identified. Patient characteristics were screened from 2017 onwards. Secukinumab dosing was reported separately for patients with and without additional manifestations of psoriatic arthritis (PsA) and psoriasis (PSO) given the variability in prescribing recommendations.

RESULTS: This study identified 1,402 patients with axSpA initiating a new bDMARD, 236 of those (16.8%) were bDMARD-experienced. Overall mean age was 48.7 years. 47.5% of patients were female. Adalimumab (44%), secukinumab (16%), and etanercept (16%) were most frequently prescribed. The proportion of bDMARD-experienced patients varied across bDMARDs and was the highest amongst certolizumab pegol initiators (43%). Most bDMARDs were prescribed by rheumatologists (42%). Frequent comorbidities included hypertension (48%), PSO (32%), and depression (27%).

For axSpA patients without PsA/PSO manifestations who initiated secukinumab, 61% received 150 mg monthly at maintenance (irrespective of starting dose). 300 mg dosing ranged from 39% (without) to 77% (with PsA/PSO manifestations). Among all patients with axSpA, regardless of PsA/PSO manifestations, who initiated secukinumab, 63% received 300 mg as maintenance dose. A similar pattern was observed regardless of bDMARD-history.

CONCLUSIONS: This study characterized patients with axSpA treated with bDMARDs and suggests that factors such as biologic-experience play roles in the choice of bDMARD treatment but less so for secukinumab dosing. Future studies are warranted to identify patient outcomes associated with treatment patterns, including persistence, which can assist in tailoring therapies to patient needs.