Background Until now, anti-TNF therapies represent major improvement in the treatment of severe psoriatic arthritis. However, in France, little is known about long-term drug persistence with these treatments in patients with psoriatic arthritis in routine clinical practice.
Objectives The aim of this study was to assess persistence with first-course and second-course treatment with anti-TNF agents in a cohort of psoriatic arthritis patients and to identify factors associated with drug discontinuation.
Methods Patients with psoriatic arthritis (PsA) were identified in the database of the Teaching hospital of Montpellier using IC code. A total of 124 patients treated with anti-TNF drug were selected (first anti-TNF agent: etanercept, n=40; infliximab, n=47; and adalimumab, n=37). Persistence with treatment was examined using Kaplan-Meier survival analysis. Log-rank (Mantel Cox) analyses were used to examine potential predictors of withdrawals.
Results At baseline, the mean (standard deviation) age of patients was 47.4±12.3 years, 38% were female. Anti-TNF was combined with sDMARD in 38 patients. Median drug survival was 60 months (36.6-84.5) and 1-year and 2-year drug survival rates were 78.4% and 65% respectively. Infliximab had a significantly longer median drug retention with 99±9.7months vs 54.5±6.9 for etanercept and 23.8±6.2 for adalimumab (p<0.05) (figure). Gender, age, concomitant sDMARD were not associated with longer drug survival. The mean duration of (standard deviation) follow-up was 2.5 years ±3.8. During the period of follow-up, 65 patients received a second anti-TNF therapy (etanercept, n=22; infliximab, n=15; and adalimumab, n=22). Median drug survival was 35.5±7 months. Drug retention was not different across the three anti-TNF drugs. Again, age, gender and combination with a sDMARD were not predictive of maintenance.
Conclusions Psoriatic arthritis patients show high persistence rates with anti-TNF therapies. Surprisingly, infliximab had the best maintenance in this cohort. The 5mg/kg dose per injection and intraveinous administration may explain this longer drug retention.
Disclosure of Interest J. Morel Grant/research support from: PFIZER, Consultant for: PFIZER, ABBVIE, MSD, B. Combe Grant/research support from: PFIZER, Consultant for: PFIZER, MSD, ABBVIE, C. Daien Grant/research support from: PFIZER, Consultant for: PFIZER, ABBVIE, MSD, C. Lukas Grant/research support from: PFIZER, Consultant for: PFIZER, ABBVIE, MSD
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