title: Treatment with tumor necrosis factor inhibitors in axial spondyloarthritis: comparison between private rheumatology practices and academic centers in a large observational cohort.
abstract: OBJECTIVE
  To evaluate the initiation of and response to tumor necrosis factor (TNF) inhibitors for axial spondyloarthritis (axSpA) in private rheumatology practices versus academic centers.
  
  
  METHODS
  We compared newly initiated TNF inhibition for axSpA in 363 patients enrolled in private practices with 100 patients recruited in 6 university hospitals within the Swiss Clinical Quality Management (SCQM) cohort.
  
  
  RESULTS
  All patients had been treated with ≥ 1 nonsteroidal antiinflammatory drug and > 70% of patients had a baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4 before anti-TNF agent initiation. The proportion of patients with nonradiographic axSpA (nr-axSpA) treated with TNF inhibitors was higher in hospitals versus private practices (30.4% vs 18.7%, p = 0.02). The burden of disease as assessed by patient-reported outcomes at baseline was slightly higher in the hospital setting. Mean levels (± SD) of the Ankylosing Spondylitis Disease Activity Score were, however, virtually identical in private practices and academic centers (3.4 ± 1.0 vs 3.4 ± 0.9, p = 0.68). An Assessment of SpondyloArthritis international Society (ASAS40) response at 1 year was reached for ankylosing spondylitis in 51.7% in private practices and 52.9% in university hospitals (p = 1.0) and for nr-axSpA in 27.5% versus 25.0%, respectively (p = 1.0).
  
  
  CONCLUSIONS
  With the exception of a lower proportion of patients with nr-axSpA newly treated with anti-TNF agents in private practices in comparison to academic centers, adherence to ASAS treatment recommendations for TNF inhibition was equally high, and similar response rates to TNF blockers were achieved in both clinical settings.
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel. adrian.ciurea@usz.ch.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ciurea
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Weber
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Stekhoven
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Almut
authors.initials: A
authors.lastname: Scherer
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Tamborrini
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Jürg
authors.initials: J
authors.lastname: Bernhard
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Martin
authors.initials: M
authors.lastname: Toniolo
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Villiger
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Pascal
authors.initials: P
authors.lastname: Zufferey
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Rudolf O
authors.initials: RO
authors.lastname: Kissling
authors.affiliation: From the Department of Rheumatology, University Hospital; Department of Rheumatology, Uniklinik Balgrist; Swiss Clinical Quality Management Foundation, Zurich; Department of Rheumatology, Bethesda Hospital, Basel; Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn; Department of Rheumatology and Clinical Immunology, University Hospital, Bern; Department of Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne; Praxis Rheuma-Basel, Basel, Switzerland.A. Ciurea, MD; M. Toniolo, MD; B.A. Michel, MD, Department of Rheumatology, University Hospital Zurich; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; R.O. Kissling, MD, Uniklinik Balgrist; D. Stekhoven, PhD; A. Scherer, PhD, SCQM Foundation; G. Tamborrini, MD, Bethesda Hospital; J. Bernhard, Department of Rheumatology and Rehabilitation, Bürgerspital Solothurn; P.M. Villiger, MD, Department of Rheumatology and Clinical Immunology, University Hospital Bern; P. Zufferey, MD, Department of Rheumatology, Centre Hospitalier Universitaire Vaudois; P. Exer, MD, Praxis Rheuma-Basel.
authors.forename: Beat A
authors.initials: BA
authors.lastname: Michel
authors.forename: Pascale
authors.initials: P
authors.lastname: Exer
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D012219:Rheumatology; D025241:Spondylarthritis / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: AXIAL SPONDYLOARTHRITIS; TREATMENT RESPONSE; TUMOR NECROSIS FACTOR INHIBITORS