OBJECTIVES: To apply an algorithm to identify possible non-radiographic axial spondyloarthritis (nr-axSpA) patients in a German claims database, to estimate the prevalence, and describe the medical history, and biologic treatment patterns in these patients.

METHODS: A retrospective claims data analysis was conducted using the “Institut für angewandte Gesundheitsforschung” database containing anonymized German healthcare claims of about 4 million insured individuals. Patients with a diagnosis of other inflammatory spondylopathy based on the German ICD-10-GM code (M46.-) in 2013 (index quarter) and a history of back pain (M54.-) or disc disorders (M50.- to M53.-) and no diagnosis of ankylosing spondylitis (AS) (M45.-) in the individual four years pre-index period were identified as nr-axSpA patients. The diagnostic prevalence, progression rate to AS in the individual one year post-index period, medical history of patients within the four years pre-index period, and usage of biologics in a subgroup (n=852) observable for two years post-index were analyzed.

RESULTS: A total of 869 nr-axSpA patients (female: 64%, mean age: 58 years) were identified in the database, resulting in a 2013 prevalence of 26.2 per 100,000 persons in Germany. In the pre-index period, all patients visited outpatient physicians, which included radiologists (84% of patients), orthopedists (77%), dermatologists (53%), and rheumatologists (52%). More than two-thirds of the patients (71%) had at least one MRI or X-ray assessment during this period. About 13% of the nr-axSpA patients progressed to AS during the post-index period. Among the subgroup of 852 patients, 51 (6%) patients were prescribed with biologics.

CONCLUSIONS: Although differentiation between nr-axSpA and AS is difficult, the algorithm used in this study allowed the identification of possible nr-axSpA patients in claims database. Contrary to expectations, rheumatologists were not the most frequently visited physicians by nr-axSpA patients. Additional studies would greatly benefit from the establishment of a separate ICD-10-GM code for nr-axSpA in Germany.