Treatment satisfaction, disease severity, and health-care use in patients with axial spondyloarthritis in the United States and Europe.

Abstract

The heterogeneous presentation of axial SpA (axSpA) complicates diagnosis and treatment decisions. This study compared patient symptoms, health-care resource utilization, and physician-patient alignment on disease severity and treatment satisfaction between the USA and five European countries (5EU). Data were drawn from the Adelphi axSpA Disease Specific Programme (DSP)™, a real-world cross-sectional survey conducted in the USA and 5EU between March and November 2021. Rheumatologists reported on consecutive patients, including clinical characteristics, disease severity, symptomatic burden, treatment history, health-care resource utilization, and treatment satisfaction. Patients reported on disease severity, treatment satisfaction, and other validated patient-reported outcome measures. Physician-patient alignment was quantified using weighted kappa analyses. A total of 349 rheumatologists provided data for 2750 patients (USA = 656, 5EU = 2094), of whom 1011 (36.8%) self-reported data. The mean (s.d.) numbers of symptoms at diagnosis were similar [USA: 6.0 (4.4) vs 5EU: 6.4 (4.3); P = 0.0657]; however, the mean [s.d.] numbers of symptoms at data collection was greater in the USA than in 5EU [3.3 (3.3) vs 2.3 (2.8), respectively; P < 0.0001]. Physician-patient alignment on disease severity at diagnosis (κ = 0.37 vs κ = 0.47), treatment initiation (κ = 0.32 vs κ = 0.42) and data collection (κ = 0.32 vs κ = 0.61), and treatment satisfaction (κ = 0.35 vs κ = 0.42) were lower in the USA than in 5EU. The mean [s.d.] number of consultations in the previous 12 months was lower in the USA than in 5EU [5.2 (3.4) vs 6.5 (5.1); P = 0.0008], although mean hospitalizations were similar. Differences in symptomatic burden and care were observed between regions. Identifying care gaps will aid in implementing targeted improvements in treatment, minimizing the risk of health inequalities.