K. Zh. Nurgaliyev

Background/Objectives: Long-term real-world evidence on golimumab in axial spondyloarthritis (axSpA) from Central Asia is limited. We evaluated clinical outcomes through week 144, treatment persistence through 36 months, factors associated with discontinuation, and reasons for discontinuation in Kazakhstan. Methods: This prospective observational cohort included 113 adults with axSpA enrolled at two rheumatology centers in Almaty in October 2019. All had received golimumab 50 mg subcutaneously every four weeks for at least 12 weeks before enrollment. Time zero for persistence analyses was the enrollment date. Clinical assessments were performed at baseline and weeks 12, 24, 52, 104, and 144. Treatment persistence was estimated using Kaplan–Meier analysis, and factors associated with confirmed discontinuation were explored using Cox regression. Clinical responses were assessed using non-responder imputation (NRI; N = 113). Results: During 36 months, 24 patients had confirmed permanent discontinuation; two patients lost to follow-up without confirmed discontinuation were censored. Kaplan–Meier estimated persistence was 89.3% (95% CI, 83.8–95.2%) at 12 months, 79.4% (72.2–87.3%) at 24 months, and 78.5% (71.2–86.5%) at 36 months. Among 88 patients with paired baseline and week 144 assessments, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score based on erythrocyte sedimentation rate (ASDAS-ESR), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) improved significantly (all p < 0.001). With NRI, 64.6% achieved BASDAI50, 59.3% ASDAS inactive disease, and 54.9% ASDAS major improvement at week 144. Higher Rheumatic Disease Comorbidity Index (RDCI) score (adjusted hazard ratio [HR] 1.312, 95% CI, 1.042–1.653) and functional class III–IV versus I–II (adjusted HR 2.412, 95% CI, 1.037–5.611) were associated with higher discontinuation hazards in exploratory analyses. Loss of effectiveness was the most frequent reason for discontinuation (54.2%). Adverse events were recorded only when they led to discontinuation and therefore do not represent overall safety incidence. Conclusions: Golimumab was characterized by substantial 36-month treatment persistence and clinical improvement among patients who remained on treatment and were evaluable at week 144 (n = 88). Full-cohort NRI analyses also demonstrated clinically relevant responses at week 144. Comorbidity burden and poorer functional class were associated with discontinuation in exploratory analyses. These findings add long-term real-world evidence from an under-represented geographic setting.

Objective: to study and analyze the dynamics of prevalence, demographic, social, and clinical manifestations of systemic lupus erythematosus (SLE) in patients living in Kazakhstan.Materials and methods. Official materials of the Ministry of Health of the Republic of Kazakhstan (2009–2018): statistical compendiums, a consolidated reporting form for medical treatment (N 12). 102 patients (100 women and 2 men) were included in the register of SLE with reliable SLE according to SLICC (ACR, 2012). Assessment of the debut of the disease was carried out according to archival material (medical history, outpatient records) of patients. The activity of the process was evaluated according to SLEDAI-2K, organ damage according to SLICC/ACR (2000).Results. The total number of patients with SLE over 10 years (2009–2018) more than doubled, the growth rate was 101%. The overwhelming majority of patients with SLE are women (91%). In the study group, Asians (83.33%) predominated by race, of which Kazakhs (76.47%) were young (mean age – 33.85±10.58 years), with a disease duration of 5 (2; 9) years, time from the appearance of the first signs to verification of SLE – 4.5 (3; 12) years. The prevailing acute (49.0%), subacute (33.3%), rather than chronic (18.7%) variants of the course, with high activity according to SLEDAI-2K – 17.64±8.80. The most common clinical manifestations of the disease: skin lesions (98%), joints (79.4%), nervous system (49%), hematological (54.9%) and immunological (100%) disorders. The absence of organ damage (0 points) was detected in 10 (9.8%) cases, low (1 point) – in 21 (20.6%), medium (2–4) – in 61 (59.8%), high (over 4) – in 10 (9.8%) patients.Conclusion. SLE remains a socially significant disease in Kazakhstan, as evidenced by the dynamics of the increase in incidence (101%) over 10 years (2009–2018). The prevalence of SLE is 24.7 per 100 thousand of the country’s population, lower than in other countries with a predominant Asian population or in comparison with Asian populations. A cohort of patients with SLE was represented by people of the Asian race (83.33%), Kazakhs (76.47%), and young people (33.85±10.58). The analysis revealed a delayed verification of the diagnosis of SLE (on average 4.5 (3; 12) years). Acute variants of the course of the disease with high disease activity according to SLEDAI-2K prevail. Common clinical manifestations of SLE are skin lesions, both acute and chronic (98%), joints (79.4%), damage to the nervous system (49%), hematological (54.9%) and immunological disorders (100%).