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Factors Associated With Initiation of Biologics in Patients With Axial Spondyloarthritis in an Urban Asian City


Png, Wan Yu, BSc (Pharm)(Hons)*; Kwan, Yu Heng, BSc (Pharm)(Hons); Lee, Yi Xuan, BSc (Pharm)(Hons)*; Lim, Ka Keat, MPharm, MSc; Chew, Eng Hui, BSc (Pharm)(Hons), PhD (Pharm)*; Lui, Nai Lee, MBBS, MMed, MRCP, FAMS; Tan, Chuen Seng, BSc, MSc, PhD§; Thumboo, Julian, MBBS, MMed, MRCP, FAMS, FRCP‡∥¶; Østbye, Truls, MD, MPH, MBA, PhD, FFPH; Fong, Warren, MBBS, MRCP, FAMS‡∥¶

JCR: Journal of Clinical Rheumatology: March 2019 - Volume 25 - Issue 2 - p 59–64
doi: 10.1097/RHU.0000000000000762
Original Articles

Objective The aim of this study was to examine if patients' sociodemographic, clinical characteristics, and patient-reported outcomes were associated with biologics initiation in patients with axial spondyloarthritis in Singapore.

Methods Data from a dedicated registry from a tertiary referral center in Singapore from January 2011 to July 2016 were used. Initiation of first biologics was the main outcome of interest. Logistic regression analyses were used to explore the association of various factors on biologics initiation.

Results Of 189 eligible patients (aged 37.7 ± 13.3 years; 76.2% were males), 30 (15.9 %) were started on biologics during follow-up. In the multivariable analysis model, age (odds ratio [OR]; 0.93; 95% confidence interval [CI], 0.89–0.98; p < 0.01), mental component summary score of Short-Form 36 Health Survey (OR, 0.18; 95% CI, 0.03–0.89; p = 0.04), erythrocyte sedimentation rate (OR, 1.02; 95% CI, 1.00–1.04; p = 0.02), presence of peptic ulcer disease (OR, 10.4; 95% CI, 2.21–48.8; p < 0.01), and lack of good response to nonsteroidal anti-inflammatory drugs (OR, 4.44; 95% CI, 1.63–12.1; p < 0.01) were found to be associated with biologics initiation.

Conclusions Age, erythrocyte sedimentation rate, mental component summary score, comorbidities of peptic ulcer disease, and responsiveness to nonsteroidal anti-inflammatory drugs were associated with biologics initiation. It is essential that clinicians recognize these factors in order to optimize therapy.

From the *Department of Pharmacy, National University of Singapore;

Program in Health Services and Systems Research, Duke-NUS Medical School;

Department of Rheumatology and Immunology, Singapore General Hospital;

§Saw Swee Hock School of Public Health, National University of Singapore;

Duke-NUS Medical School; and

Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

W.Y.P. and Y.H.K. are co–first authors (equal contribution).

T.Ø. and W.F. are co–corresponding authors (equal contribution).

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors declare no conflict of interest.

Correspondence: Truls Østbye, MD, MPH, MBA, PhD, FFPH, Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169857. E-mail: Warren Fong, MBBS, MRCP, FAMS, Department of Rheumatology and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore 169856. E-mail:

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