Background Recent studies have suggested that early and aggressive treatment of spondyloarthritis, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA), may be associated with favorable patient outcomes, reducing synovial inflammation, delaying joint damage, and maintaining functional status.
Objectives The objective of this analysis was to determine the predictive factors of early DAS28 improvement in PsA patients treated with infliximab (IFX) or golimumab (GLM) in a Canadian routine clinical care setting.
Methods BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM. The analysis was based on PsA patients treated with IFX or GLM between 2005 and 2014. Variables associated with improved response were examined using general linear models and those showing a statistical trend (P<0.150) were considered in multivariate analysis to identify independent predictors.
Results A total of 176 patients were included in the analysis with a mean (SD) age of 49.4 (11.4) years and a disease duration of 5.2 (7.2) years. The majority of patients were male (54.1%). Upon 6 months of treatment statistically significant and clinically meaningful improvements were observed in DAS28 (4.1 vs. 2.9; P<0.001), HAQ (1.05 vs. 0.78; P<0.001), TJC (5.0 vs. 2.6; P<0.001), SJC (3.7 vs. 1.6; P<0.001), pain (46.8 vs. 30.7 mm; P<0.001), PtGA (48.6 vs. 29.7 mm; P<0.001), MDGA (5.3 vs. 2.3 cm; P<0.001), and morning stiffness (65.8 vs. 45.0 min; P<0.001).
In univariate analysis, male gender (male vs. female: B=-0.806; P=0.029), not smoking (smokers vs. non-smokers: B=0.984; P=0.131), no previous use of a biologic (naïve vs. experienced: B=-1.995; P<0.001), presence of dactylitis (no vs. yes: B=0.746; P=0.073), and higher disease activity (DAS28 B=-0.525; P<0.001) were associated with greater improvements in DAS28 at six months of treatment. Age, disease duration, number of prior DMARDs, ongoing DMARD use, ongoing steroid use, ongoing NSAID use, presence of enthesitis, presence of nail pitting, and number of peri-articular manifestations did not show any effect on the change in DAS28. Multivariate analysis showed that, upon adjusting for baseline disease severity, male gender (B=-0.838; P=0.056) and no prior exposure to a biologic (B=-2.693; P=0.001) were significant predictors of improved response.
Conclusions Six-month treatment with IFX or GLM in a real-world setting was associated with significant improvements in all disease parameters studied. Upon adjusting for potential confounders, no prior exposure to a biologic and male gender were identified as independent predictors of greater DAS28 improvement.
Disclosure of Interest D. Sholter Consultant for: Janssen, J. Kelsall Consultant for: Janssen, R. Arendse Consultant for: Janssen, A. Avina-Zubieta Consultant for: Janssen, W. Bensen Consultant for: Janssen, M. Zummer Consultant for: Janssen, R. Faraawi Consultant for: Janssen, S. Dixit Consultant for: Janssen, M. Khraishi: None declared, I. Fortin Consultant for: Janssen, J. Sampalis: None declared, E. Psaradellis: None declared, F. Nantel Employee of: Janssen, C. Tkaczyk Employee of: Janssen, A. Lehman Employee of: Janssen