ObjectivesTo assess the frequency of patients in drug-free remission at 5 years in a cohort of early axial SpA, and the factors associated with this remission.MethodsPatients: patients included in the DESIR (DEvenir des Spondyloarthropathies Indifférenciées Récentes) cohort undergoing the 5-year visit were selected for this analysis. Definition of 5-year drug-free remission: (1) all patients in ASAS partial remission and/or ASDAS < 1.3 at 5 year visit and (2) taking no disease modifying anti-rheumatic drugs at the 5-year visit and (3) with an ASAS-NSAID score ≤ 25 at the 5-year visit. Data analysis: the proportion of patients in drug-free remission was described. The association between demographic, clinical, biological and imaging characteristics and drug-free remission at 5 years was assessed by logistic regression.ResultsOf the 412 patients included in this analysis, 73 (18%) were in drug-free remission at the 5-year visit. The baseline clinical factors associated with the chances to be in drug-free remission at the 5-year visit were symptom duration (OR = 0.66 [95%CI%: 0.44–0.97]), lower HAQ-AS score (OR = 0.32 [0.12–0.78]), lower ASDAS score (OR = 0.55 [95%CI: 0.34–0.86]), ASAS-NSAID score (OR = 0.91 [95%CI: 0.82–0.99]). Furthermore, anti-TNF use (OR = 0.20 [95%CI: 0.08–0.42]) during the follow-up decreased the chances of being in 5-year drug-free remission.ConclusionThe probability of being in drug free remission at 5 year when beginning an axial SpA is low and is associated with lower baseline disease activity and functional scores, while starting an anti-TNF is associated with poor chances of later being in drug-free remission.