This study examined how national socioeconomic indicators (GDP per capita, HDI, gross national income, health expenditure, out-of-pocket expenditure) relate to b/tsDMARD treatment retention at 6, 12, and 24 months and disease activity at treatment initiation in 38,911 patients with PsA (n=17,296) or axSpA (n=21,615) across 13 European countries from 2015–2021.
Higher national wealth was paradoxically associated with **earlier** b/tsDMARD discontinuation — retention was significantly lower in high-GDP countries vs. medium/low-GDP countries at 6, 12, and 24 months (log-rank P<.001 for all). Conversely, patients in lower-GDP countries started treatment with **worse disease activity**, especially in PsA. The strongest socioeconomic effects on retention were seen with GDP per capita and HDI, and were most pronounced in women with axSpA.
- Country-level (ecological) socioeconomic indicators were used rather than individual patient-level socioeconomic data, limiting causal inference. - Registry data may reflect variation in prescribing practices, access policies, and drug availability across countries rather than purely socioeconomic effects. - The 2015–2021 timeframe may not reflect more recent changes in drug access or health policy across Europe.
In lower-income European countries, patients with PsA and axSpA tend to start biologics with higher disease burden and stay on them longer — possibly due to restricted switching options rather than better drug performance. Clinicians and health policy makers in these settings should actively monitor disease activity at treatment initiation and ensure timely access to treatment optimization.
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