Introduction Psoriasis arthritis (PSA) is a highly heterogeneous disease. Occasionally it courses with very aggressive forms that requiring biological therapies (TB).
Objective To evaluate the effectiveness and long-term safety of TB in a serie of patients with PSA tracking Valme Hospital area.
Methods Observational descriptive study of a series of 25 patients with diagnosis of PSA with peripheral affectation according CASPAR criteria, in treatment with TB in the UGC of Valme hospital.
Measurement of disease activity using the DAS28 index before and after TB. Survival analysis of each of the biological drugs used. Evaluation of drug safety through adverse effects (EA) collection.
Results a total of 25 patiens diagnosied with PSA with TB treatment were reviewed. Etanercept was the drug most used in first line (36%), followed by Infliximab (32%), Adalimumab (16%), Golimumab (12%) and Certolizumab (4%). In 2nd line of treatment, also Etanercept was the most used followed of Adalimumab. A single patient with highly refractory APS was treated with Abatacept in the fourth line and is currently being treated with Ustekinumab in the 5th line.
Regarding efficacy data for the first biological: DAS 28 values before the onset of TB were: 20% High, 60% moderate, 8% low and 12% in remission (patiens in remission had the indication of TB by the cutaneous affectation). At the cut-off point after the first biology, we found:
All the patients who were in remission and with low activity,becuse were wtih TB due to cutaneous involvement continued with the same values of DAS 28.
The rest of the patients with TB, we found after treatment with the first drug 60% were in remission, 24% low activity and 16% remained with moderate activity. By means of the Student’s T for paired samples in relation to the DAS28 before the drug and in the last determination of the DAS28 with that drug, we found statistically significant differences only with the first biological drug, with a p<0.0005 with a mean of Decrease in DAS 28 of 2.14 (SD 1.64).
In the case of the following treatment lines, the decrease in DAS 28 does not show statistically significant differences. Moreover, in the evaluation of successive TB, the sample size does not allow us to establish efficacy data with statistical significance.
Survival time with the first drug was: the median 14 months (mininum 3 months and max 156 months)
The most frequent adverse effects: infections of upper respiratory tract, urinary tract and recurrent cold sores). Reactions at the injection site. We dont have any cases of death.
The most frequent reasons for drug suspension in the first line, was secondary failure (40% of cases) followed by a 30% of primary failure and the appearance of adverse effects
Discussion TB is an effective and safe option of treatment that should be considered in patients with moderate to severe PAs, who are resistant to classical therapies or who have contraindications to conventional drugs.
Although approximately 1/3 of the patients do not respond to these treatments, new trherapies as inhibitor to IL 17 and IR 12–23 pathways are promising and represent another alternative treatment for this patiens.
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