OBJECTIVES: Axial Spondyloarthritis (AxSpA) is a type of inflammatory rheumatic disease that is chronic in nature and can cause severe disability. As biologics play a crucial role in managing AxSpA, it is important for clinicians to understand why biologics are initiated or refused. Hence, we aim to examine if patient’s sociodemographic, clinical characteristics, and patient reported outcomes were associated with biologics initiation in patients with AxSpA in Singapore. METHODS: Data from a dedicated registry, the PREcision medicine in SPondyloarthritis for better Outcomes aNd Disease remission (PRESPOND) from a tertiary referral centre 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 duration of disease, age, employment status, BASDAI, SF-36 (PCS and MCS), ESR, comorbidities of peptic ulcer disease (PUD) and skin symptoms, as well as responsiveness to NSAIDs on biologics initiation. RESULTS: Of 189 eligible patients (age 37.7 ± 13.3 years, 76.2% males), 30 (15.9 %) were started on biologics during follow-up. In the univariable analyses, higher ESR (OR=1.02; 95%CI 1.00-1.03; p=0.03) as well as presence of PUD (OR=3.78; 95%CI 1.14-12.5; p=0.03) were associated with higher odds of biologics initiation. Older age (OR=0.96; 95%CI 0.93-1.00; p=0.03) and good response to NSAIDs (OR=0.32; 95%CI: 0.14-0.72; p<0.01) were associated with lower odds. In the multivariable model, age (OR=0.93; 95%CI 0.89-0.98; p<0.01), MCS of SF-36 (OR=0.18; 95%CI 0.03-0.89; p=0.04), ESR (OR=1.02; 95%CI 1.00-1.04; p=0.02), presence of PUD (OR=10.4; 95%CI 2.21-48.8; p<0.01) and good response to NSAIDs (OR=0.23; 95%CI 0.08-0.61; p<0.01) were found to be associated with biologics initiation. CONCLUSIONS: Age, ESR, MCS of SF-36, comorbidities of PUD and responsiveness to NSAIDs were associated with biologics initiation. Thus, clinicians might consider using these factors to guide biologics treatment in patients.