Mortality in Ankylosing Spondylitis According to Treatment: A Nationwide Retrospective Cohort Study of 5900 Patients from Israel.

Objectives In this large population-based study we aimed to assess:(1)mortality in ankylosing-spondylitis(AS) patients compared to the general population.Considering demographics,comorbidities and treatment.(2)factors associated with mortality within AS patients. Methods This study was designed as a retrospective-cohort study utilizing the electronic-database of the largest health maintenance organization in Israel.All AS patients diagnosed between 2002-2018 were included.Controls were matched by age,gender,clinic, and enrollment-time.Follow-up continued until death or end of study. Results The study comprised 5,930 AS patients and 29,018 matched controls that were followed-up for a median period of 7.5 years.There were 667 deaths within the AS cohort and 2,919 deaths within controls,the mean age-at-death was 76.9 years and 77.1 years respectively(p=0.74). 3,249(55.8%) of AS patients were treated only with non-steroidal-anti-inflammtory-drugs(NSAIDs), 1,760(30.2%) were treated with tumor-necrosis-factor-α-inhibitors(TNFi),and 1,687(29.0%) with disease-modifying-antirheumatic-drugs(DMARDs).Mortality rates were increased among AS patients compared to controls with an age-and-sex-adjusted HR of 1.19(95%CI1.10-1.30).The association was significant for men(HR=1.15,95%CI 1.04-1.27) and women(HR=1.32,95%CI 1.13-1.54), and after adjusting for background comorbidities (HR=1.14,95%CI 1.05-1.24).AS patients treated with TNFi or with a combination of TNFi and DMARDs did not have significant difference in mortality rates compared to controls(HR=0.67,95%CI 0.38-1.18;HR=0.93,95%CI 0.69-1.25;respectively).Age,male-gender,mean C-reactive-protein(CRP) levels and general comorbidities were predictors of mortality within the AS cohort. Conclusion AS patients had increased mortality risk compared to the general population after adjusting for age, sex, and baseline comorbidities.AS patients treated with TNFi did not demonstrate excess mortality compared to matched controls.Within the AS cohort age, male-gender, background comorbidities, and higher CRP levels were identified as risk factors for mortality.