Sustained response to long-term biologics and switching in psoriatic arthritis: results from real life experience

Laura C Coates ¹, Lorna S Cawkwell ¹, Nora W F Ng ¹, Alexander N Bennett ¹, Domini J Bryer ¹, Alexander D Fraser ¹, Paul Emery ^2* and Helena Marzo-Ortega ¹

¹ University of Leeds, United Kingdom
² Dept of Rheumatology, United Kingdom

^* To whom correspondence should be addressed. E-mail: p.emery{at}leeds.ac.uk.

Accepted 20 November 2007

Abstract

Objective: To investigate the response to biologic drugs in psoriatic arthritis and to quantify non-response and outcome from switching agents.

Methods: 60 patients (33M:27F, mean age 46 years, median disease duration 16 years) prescribed biologic drugs for psoriatic arthritis between 2001 and 2006 were studied. Response was evaluated using joint counts, CRP levels and DAS28 scores.

Results: The mean percentage improvements seen were 56% in tender joint count, 70% in swollen joint count, 64% in CRP level and 36% in the overall DAS score. Improvements were sustained beyond 24 months with no loss of effect. Side-effects leading to cessation or switching of first-line therapy were only seen in 5% of patients and non-response occurred in 20% long term. Overall, 90% of patients achieved a significant response, using switching in 20% of cases. Outcomes were similar regardless of drug used, duration of disease and sub-type of arthritis.

Conclusion: Treatment of active PsA with anti-TNF agents leads to a sustained response over three years with most patients tolerating these drugs well. The rate of non-response is low with the majority of patients responding to second and third line therapies.

Keywords: TNF blockers, biologics, non-response, psoriatic arthritis, switching

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