OBJECTIVES : Drug survival is a comprehensive outcome measure covering effectiveness, safety, and patients’ and doctors’ preferences. It is also a well-known and comprehensive proxy of the performance of biological therapy in a real-world setting. The aim of this analysis was to assess the drug survival of biologics in treating ankylosing spondylitis.We conducted a systematic review and meta-analysis of real-world evidence on the drug survival of biologics in treating ankylosing spondylitis.

METHODS : We searched the PubMed, CENTRAL, and EMBASE from inception to 1st April 2019 for studies reporting the annual drug survival for at least 1 year. The Newcastle-Ottawa Scale using three categories (selection of study groups, comparability, and outcome assessment) was employed to evaluate the risk of bias of included studies.

RESULTS : We conducted a random-effects model meta-analysis to obtain the respective pooled drug survival from year 1 to 5. Subgroup analyses include biologic-naïve subjects, discontinuation for loss of efficacy and adverse effects. We included 17 studies with 4,849 subjects. The drug survival for all biologics decreased with time, dropping from 83% at year 1 to 54% at year 5 for etanercept, from 81% to 65% at year 4 for adalimumab, from 82% to 54% at year 5 for infliximab, and from 80% to 64% at year 2 for golimumab. Adalimumab was associated with the highest drug survival in all and biologic-naïve subjects for ankylosing spondylitis patients at year 3 and year 4. In ankylosing spondylitis, drug survival associated with discontinuation due to adverse effects at year 5 of different TNFi is comparable.

CONCLUSIONS : This study provided evidence that TNFi discontinuation rate of patients with ankylosing spondylitis seems to be similar. Clinicians may use this study as a reference in treating ankylosing spondylitis.