NSAIDS REMAIN WIDELY USED IN AS AND PSA DESPITE THE INCREASING USE OF BIOLOGIC THERAPIES
Safi Alqatari, Roberta Visevic, , Grainne Murphy, John Ryan
Rheumatology Department, CORK UNIVERSITY HOSPITAL
Ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are chronic inflammatory diseases for which NSAIDs are recommended. Widespread publicity regarding the adverse cardiovascular risk with NSAIDs has resulted in a dramatic decrease in its use in patients with rheumatoid arthritis, however there are limited data regarding NSAID use in patients with AS or PsA. We sought to determine the prevalence of NSAID use in our hospital practice, and the prevalence of prescription of synthetic DMARDs and biologic therapies in the same cohort. Access to biologics is perceived to be generous in Ireland compared to other countries which may influence prescribing patterns.
To identify patients attending the rheumatology clinic in Cork University Hospital, Ireland with a clinical diagnosis of AS or PsA. To determine the prevalence of NSAID use in this cohort.
All patients attending the rheumatology clinics over a 1 month period in 2016 were evaluated. A review of all AS and PsA patients identified was undertaken to record the medications prescribed at the time of review with particular attention to NSAID use.
Over the month in question, 39 patients were identified with AS and 52 with PsA. had PsA.
Of the 39 AS, 16/39 (43.59%) were taking NSAIDs, 11 (28.2%) as monotherapy. 60% were treated with a biologic agent. TNF inhibitors, namely Golimumab and Etanercept (7 patients equally) were the most common, followed by Adalimumab (6). 3/39 received secukinumab. 8/39 (20.5%) received sDMARDs, with 3 (7.6%) as monotherapy.
Regarding PsA, 37% used NSAIDs, 21% used it as monotherapy. 21 patients (40.4%) were receiving TNF inhibitors, 8 as a monotherapy. The most commonly used bDMARD was adalimumab (13). 30/52 (58%) were treated with a sDMARD, and used as monotherapy in 20% . Methotrexate was the most commonly used (50%).
Despite the publicised concerns regarding the CVD risk associated with NSAIDs they remain commonly used in patients with PsA and AS. This is despite the relatively high use of biologics in this population. While NSAID use was higher than we expected it was not as high as that previously reported in a German population (67%) with AS. Publicity in relation to the adverse cardiovascular outcomes associated with NSAIDs does not appear to have reduced their use in populations with spondyloarthropathy.