Background The use of TNF-inhibitors in psoriatic arthritis (PsA) has been shown to improve clinical and radiographic outcome in randomized controlled trials (RCT) and shown to be well tolerated with a rather low rate of drop outs. However, patients in RCT may not be representative of patients followed in ordinary clinical practice.
Objectives To assess drug survival of TNF-inhibitor treatment in patients with PsA treated in an ordinary rheumatology clinic in Norway.
Methods The PsA patients were recruited from an ordinary rheumatology clinic in Norway. All PsA patients in this clinic are monitored and outcome measures and drug data is registered in a clinical hospital computer database. In the database termination and/or change of therapy had been registered. A survival analysis (Kaplan-Meyer) was performed and survival time for sequential therapeutic regimens were compared by Wilcoxon test. Anonymised data was analyzed using SPSS.
Results We identified 148 patients with PsA who started treatment with their first TNF-inhibitor (from 2002 through 31.12.2012). During the first year of therapy 52 (35%) of these patients stopped treatment. 54 patients started their second and 22 patients started their third or more TNF-inhibitor, and within the first year 33 (61%) and 12 (55%), respectively, stopped treatment. The rate of patients who stopped treatment was highest in the beginning and lover during follow up. This was also seen for the second and ≥ 3rd TNF inhibitor. Overall drug survival was significantly higher for the first TNF-inhibitor compared to the second drug (p<0.001; fig. 1). The median survival time for the first, second and subsequent drug was 24, 7, and 9 months.
Conclusions In an ordinary clinic setting, patients with PsA have a significantly reduced drug survival for the subsequent TNF-inhibitor if they fail on the first drug. For each drug, the first year of treatment had the highest termination rate.
Mease P et al. Arthritis Rheum 04;50:2264-72.
Kavanaugh A et al. ARD 07;66:498-505.
Disclosure of Interest G. Haugeberg Shareholder of: and founder of DiaGraphIT manufacturing the GoTreatIT computer system, Grant/research support from: Urestricted research grant from Pfizer, A. Gulati: None Declared, A. Diamantopoulos: None Declared, M. Hoff: None Declared, A. Kavanaugh: None Declared