Background: The use of TNF blocking agents in psoriatic arthritis (PsA) is increasing, and the SSATG register has followed patients with PsA for more than 5 years.
Objective: To present efficacy and tolerability data of TNF-blocking agents on PsA in clinical practice. Also to study potential predictors for drug survival. Material and Methods: Patients (n=261) with active PsA, starting anti-TNF therapy for the first time in southern Sweden, were included. Basal characteristics, disease activity measures, and termination reason for TNF-blockers were prospectively collected during the period April 1999 to September 2006. Cox proportional hazard models were used to investigate predictors for treatment termination.
Results: Overall, response rates at 3-12 months for VASglobal50 and VASpain50 were about 50%, whereas response rates for EULAR overall and EULAR good were around 75% and 55%, respectively. Concomitant MTX (HR=0.64 (95% CI 0.39-0.95), p=0.03), etanercept (HR=0.49 (0.28-0.86), p=0.01), and high CRP-levels (HR=0.77 (0.61-0.97), p=0.03) at treatment initiation were associated with better overall drug survival. The improved drug survival of concomitant MTX appeared to be related to significantly fewer drop outs because of adverse events (HR= 0.24 (0.11-0.52), p<0.01). The TNF-blockers were well tolerated with a rate of serious adverse events of 5-6% per year. No unexpected serious adverse events were observed.
Conclusion: Concomitant MTX and high CRP-levels are associated with treatment continuation of anti-TNF therapy in patients with PsA regardless of joint distribution. The positive effect of MTX was primarily linked to fewer drop outs because of adverse events.
- TNF blockers
- biologics register
- psoriatic arthritis