Objectives To evaluate the performance of anti-TNF drugs in psoriatic arthritis (PsA) in a routine care setting.
Methods Observational study conducted in PsA patients recruited from a tertiary rheumatology clinic in the North of France. PsA was classified according to the CASPAR and/or Moll and Wright criteria. Inclusion criteria were patients with PsA who started infliximab, etanercept, adalimumab or golimumab therapy between April 2001 and December 2012, followed for up to 6 months. Treatment of peripheral forms was considered to be effective when the patients obtained a favorable expert opinion or >30% clinical improvement of swollen and tender joint counts. Treatment of axial forms was considered to be effective for an improvement in BASDAI of at least 2 on a scale of 0-10 or 50% improvement (BASDAI 50) or favorable expert opinion. Drug survival of the first anti-TNF was investigated and drug survival was compared between patients with and without cs-DMARD co-medication and between infliximab, etanercept and adalimumab. Cox regression was used to identify predictors of discontinuation of the first anti-TNF drug.
Results The study included 193 patients (107/86 M/F, mean age 46.8 yrs, mean disease duration 6.7 yrs, 171/22 peripheral/axial forms). Only 48 (25%) were on a concomitant cs-DMARDs (65% on methotrexate). The majority of patients were started on first-line etanercept (n=102), followed by adalimumab (n=46), infliximab (n=44) and golimumab (n=1). At 3 months, 90% of patients had obtained an adequate response, 7% had discontinued due to lack of efficacy and 3% due to adverse events. Significantly decreased values for swollen and tender joints, BASDAI, erythrocyte sedimentation rate and C-reactive protein were observed within 3 months after initiation of first anti-TNF (p<0.01 for all). Median drug survival was 2.0 years [0.1-15.7], and 1-year and 2-year drug survival rates were 77% and 67%, respectively. The crude retention rates were similar among patients receiving infliximab, adalimumab, and etanercept (p>0.05). Drug survival was not superior in patients receiving co-medication (p>0.05). Discontinuation was reported in 95 patients (49%) and, on Cox regression analysis, previous cardiovascular disease was an independent predictor of discontinuation of the first anti-TNF (odds ratio [OR] 5.02, 95%CI: 1.06-23.9, p=0.04). Seventy nine (41%) patients switched to a second anti-TNF and 29 to a third anti-TNF; 80% of switchers responded to second-line and 83% responded to third-line therapy.
Conclusions In these patients receiving their first anti-TNF for PsA treated in routine clinical practice, high drug adherence and response rates were observed and pre-existing cardiovascular disease was an independent predictor of discontinuation. Moreover, 80% of patients obtained a response to second- or third-line anti-TNF after having failed one or two anti-TNF drugs.
Disclosure of Interest None declared
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