Background Patients with psoriatic arthritis (PsA) commonly receive therapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), either alone or in combination with biologics such as tumour necrosis factor inhibitors.1
Objectives To assess the evolution of real-world biologic treatment patterns in patients with PsA by comparing patient data from two distinct patient surveys from 2014 and 2011.
Methods This was a retrospective, cross-sectional analysis of data from two independent surveys (Adelphi Real World PsA Disease Specific Programmes) conducted in Q1 2011 and Q3 2014. Rheumatologists provided patient demographics, clinical details, treatment history and levels of satisfaction with disease control. Patient-reported outcomes included satisfaction with disease control, EuroQol-5 Dimension, Work Productivity and Activity Impairment (WPAI) and Alternative Health Assessment Questionnaire Disability Index (without aids/devices, HAQ-DI). Statistical differences were assessed using Mann-Whitney-U tests and Fisher's exact tests for quantitative and categorical outcomes, respectively. Missing data were not imputed.
Results Patients with PsA receiving biologic treatment were similar in age, sex and body mass index in 2014 (n=325) and 2011 (n=326). The two independent cohorts showed no difference in time since diagnosis, severity of PsA prior to initiation of current treatment, disease progression prior to initiation of current treatment and time on current biologic treatment. The 2014 cohort had milder PsA vs the 2011 cohort (mild/moderate/severe: 72.6%/24.9%/2.5% vs 59.8%/35.0%/5.2%, respectively; P=0.0004), fewer patients who had ever experienced an acute episode (36.4% vs 56.6%, respectively; P<0.0001) or experienced an acute episode in the last 12 months (21.9% vs 31.4%, respectively; P=0.0074) and more patients with better current disease status (improving/stable/deteriorating slowly/deteriorating rapidly/unstable: 31.4%/56.7%/1.6%/7.2%/3.1% vs 27.3%/52.2%/14.4%/3.1%/3.1%, respectively; P=0.045). Patients did not receive biologic treatment any earlier in 2014 (median [interquartile range]; 36 [12, 72] months in 2014 vs 33 [15, 63] in 2011, P=0.2261). The number of csDMARDs received prior to initiation of biologic treatment did not differ significantly in 2014 vs 2011 (P=0.1551). Both physicians and patients were more satisfied with control of PsA in 2014 vs 2011 (81.5% vs 71.8%, P=0.0016 and 90.9% vs 67.3%, P=0.0002, respectively). The HAQ-DI score was significantly lower, indicating better health, in 2014 vs 2011 (0.38 [0.00, 0.88] vs 0.63 [0.27, 1.00], respectively; P=0.0065). WPAI scores showed nonsignificant improvements in outcomes in 2014 compared with 2011.
Conclusions There were no significant differences in severity of PsA at initiation of treatment or treatment patterns in the patient samples analysed in 2014 vs 2011; however, patients' disease status was improved and both patients and physicians were more satisfied with the control of PsA in 2014 than in 2011. Further investigation is required to elucidate the reasons behind the improved outcomes observed over time.
Soriano ER, et al. Best Pract Res Clin Rheumatol. 2014;28:793–806.
Disclosure of Interest J. Lucas Employee of: Adelphi Real World, R. Wood Employee of: Adelphi Real World, J. Piercy Employee of: Adelphi Real World, J. C. Cappelleri Shareholder of: Pfizer, Employee of: Pfizer, B. Kola Shareholder of: Pfizer, Employee of: Pfizer, A. Chhabra Shareholder of: Pfizer, Employee of: Pfizer, R. Vasilescu Shareholder of: Pfizer, Employee of: Pfizer, M.-A. Hsu Shareholder of: Pfizer, Employee of: Pfizer