Internal medicine care linked to superior TNFi retention for radiographic axial spondyloarthritis in Korea

Patients with radiographic axial spondyloarthritis (r-axSpA), a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, often require long-term treatment with tumor necrosis factor inhibitors (TNFis) to manage symptoms and prevent structural damage. Despite their efficacy, treatment adherence and persistence can vary, impacting long-term outcomes. While specialist care is generally associated with better management of complex conditions, the specific impact of different medical specialties on TNFi retention in r-axSpA has not been definitively established, creating a gap in understanding optimal care pathways and identifying areas for improved treatment continuity.

Researchers conducted a nationwide observational study using the Health Insurance Review and Assessment Service claims data from January 1, 2011, to June 30, 2022. They identified 5,944 patients diagnosed with r-axSpA who initiated their first TNFi treatment. The study assessed baseline characteristics, TNFi retention rates by prescribing specialty (internal medicine, orthopedics, neurosurgery, and other departments), and the risk of discontinuation for specific TNFi agents including adalimumab, etanercept, infliximab, and golimumab. Cox proportional hazards models were employed to estimate hazard ratios (HRs) for TNFi discontinuation, comparing retention across specialties.

Among the 5,944 TNFi initiators, the most commonly prescribed agents were adalimumab (n = 2,543), golimumab (n = 1,499), etanercept (n = 1,026), and infliximab (n = 876). The vast majority of patients (n = 5,102, 85.8%) received treatment from internal medicine departments, followed by orthopedics (n = 622, 10.5%), neurosurgery (n = 185, 3.1%), and other departments (n = 35, 0.6%). TNFi retention was consistently highest in patients managed by internal medicine specialists. In multivariable analyses, the risk of TNFi discontinuation was significantly elevated in other specialties compared to internal medicine:

The risk of discontinuation was 1.24 times higher in orthopedics (95% CI 1.11-1.37, p < 0.001), 1.82 times higher in neurosurgery (95% CI 1.53-2.16, p < 0.001), and 2.41 times higher in other departments (95% CI 1.72-3.36, p < 0.001).