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Biologics Prescribed More Often for AS Than nr-axSpA Despite Similar Disease Burden

March 10, 2021

Although patients with ankylosing spondylitis (AS) and patients with non-radiographic axial spondyloarthritis (nr-axSpA) share many of the same symptoms and a similar burden of disease, those with nr-axSpA are less likely to be prescribed a biologic in the United States. Researchers published their findings online ahead of print in Clinical Rheumatology.

Noting that most previous studies comparing patients with AS and patients with nr-axSpA have taken place outside the United States, investigators surveyed 515 patients with AS and 495 patients with nr-axSpA, and their rheumatologists, within the United States to provide a national picture. Rheumatologists reported on patient demographics, symptoms, and medication use, while patients answered work disability and quality of life questions. 

“The most important finding of our study is that despite the similar burden of disease, patients with nr-axSpA are receiving biologics less commonly than AS patients,” researchers reported. “Over two-thirds of AS patients were prescribed biologic therapy either as a monotherapy or in combination with a conventional disease-modifying antirheumatic drug (cDMARD). In comparison, only 59.6% of nr-axSpA patients were prescribed biologic therapy.” 

More than a third of patients with nr-axSpA were prescribed a cDMARD or nonsteroidal anti-inflammatory drug, the study showed, compared with a quarter of patients with AS.  

Patients with AS were more likely to be male, older, and working full-time compared with patients with nr-axSpA. Patient’s global assessment, physician’s global assessment, current pain levels, and quality of life were similar between those with AS and those with nr-axSpA, according to the study. 

“The shared characteristics of these AS and nr-axSpA patients are consistent with the prevalent opinion that AS and nr-axSpA are two subtypes on the spectrum of axSpA,” researchers concluded. “AS and nr-axSpA patients face the same burden and need the same level of access to targeted advanced treatment.” 

Jolynn Tumolo


Hunter T, Sandoval D, Booth N, Holdsworth E, Deodhar A. Comparing symptoms, treatment patterns, and quality of life of ankylosing spondylitis and non-radiographic axial spondyloarthritis patients in the USA: findings from a patient and rheumatologist Survey [published online ahead of print, 2021 Feb 20]. Clin Rheumatol. 2021;10.1007/s10067-021-05642-6. doi:10.1007/s10067-021-05642-6

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