Background Psoriatic arthritis (PsA) is an inflammatory condition affecting joints and often occurs in combination with a skin disorder called psoriasis. In recent years biologic therapies have become widely used for this condition and have significantly improved outcomes for patients. Despite these innovations, little is known about what the most important clinical considerations in biologic treatment of PsA are, and how biologics perform against key clinical domains important in practice.
Objectives This study seeks to understand the importance of biologic safety, efficacy, sustainability (duration of response), and speed (onset of action) in the treatment of PsA, and gauge how current biologics are perceived to perform against those key clinical domains.
Methods Data were drawn from the Adelphi 2011 Rheumatology Disease Specific Programme – surveys of 100 rheumatologists in the USA. Rheumatologists rated the importance of 34 attributes describing considerations that may be of relevance when managing PsA on a 1 – 7 Likert scale (1 = no importance; 7 = extremely important). Biologic therapies indicated for PsA at the time of data collection (adalimumab, etanercept, golimumab, infliximab) were then rated against the same attributes on a Likert scale of 1 = no association to 7 = strong association.
Attributes from the list of 34 were allocated to four clinical domains of safety, efficacy, sustainability and speed. Attributes not relevant to any of the four domains were removed from the analysis. The domains were assessed using Cronbach's Alpha analysis and adjusted as appropriate to remove attributes weakening each domain's internal consistency.
The importance of each clinical domain was calculated using the mean “importance” scores across the individual attributes of each domain. Similarly, the extent of biologic therapies' association with each domain was assessed as the mean of the scores for all four of the biologic therapies across each domain's attributes.
Results Cronbach's Alpha analysis of the attribute allocation to domain groups resulted in 5 attributes in the “safety” domain (Alpha 0.87), 2 attributes in “speed” (Alpha 0.68), 1 attribute in “sustainability”, and 8 attributes in “efficacy” (Alpha 0.85).
Based on clinician ratings of the importance of these domains scores ranged from 6.57 out of a maximum of 7 for “sustainability”, 6.38 for “safety”, 5.86 for “speed” to 5.77 for “efficacy”. Biologic association with the clinical domains ranged from 5.67 out of a maximum score of 7 for sustainability through speed 5.27, safety 5.17, and efficacy 5.14.
Conclusions The scores indicate that the core domains of safety, efficacy, sustainability and speed are important themes in PsA treatment, with sustainability and safety seemingly most important. The biologic therapy “association” scores indicate that current biologics are providing a benefit in relation to these important clinical domains, however opportunity remains to more fully address each of these domains in the management of PsA.
Disclosure of Interest S. Gabriel Employee of: Novartis Pharmaceutical Corporation, E. Sullivan Consultant for: Novartis Pharmaceutical Corporation, A. Roughley Consultant for: Novartis Pharmaceutical Corporation, J. Palmer Employee of: Novartis Pharmaceutical Corporation, V. Herrera Employee of: Novartis Pharmaceutical Corporation