You are here

  • Home
  • Online First
  • Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries

Article Text

Article menu

other Versions

Download PDFPDF
Psoriatic arthritis
Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries
  1. Bente Glintborg1,2,
  2. Daniela Di Giuseppe3,
  3. Johan Karlsson Wallman4,5,
  4. Dan C Nordström6,
  5. Bjorn Gudbjornsson7,8,
  6. Merete Lund Hetland1,2,
  7. Johan Askling9,
  8. Gerdur Grondal8,10,
  9. Tuulikki Sokka11,12,
  10. Sella A Provan13,
  11. Brigitte Michelsen14,15,
  12. Eirik Klami Kristianslund14,
  13. Lene Dreyer16,17,
  14. Thorvardur Jon Love18,
  15. Ulf Lindström19
  1. 1DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen University Hospital Glostrup, Glostrup, Denmark
  2. 2Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
  3. 3Department of Medicine, Karolinska Universitetssjukhuset i Solna, Stockholm, Sweden
  4. 4Department of Clinical Sciences Lund, Skåne University Hospital Lund, Lund University, Lund, Sweden
  5. 5Department of Rheumatology, Skåne University Hospital Lund, Lund University, Lund, Sweden
  6. 6FOB-FIN and University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
  7. 7Centre for Rheumatology Research (ICEBIO), Landspitali University Hospital, Reykjavik, Iceland
  8. 8Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  9. 9Clinical Epidemiology Division, Department of Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
  10. 10Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
  11. 11Jyväskylä Central Hospital (KSSHP), Jyväskylä, Finland
  12. 12UEF, Faculty of Health Sciences, Kuopio, Finland
  13. 13Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
  14. 14Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  15. 15Research Unit, Hospital of Southern Norway Trust, Sorlandet Hospital Kristiansand, Kristiansand, Norway
  16. 16Department of Rheumatology, Center of Rheumatic Research Aalborg (CERRA), Aalborg University Hospital, Aalborg, Denmark
  17. 17Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
  18. 18Faculty of Medicine, University of Iceland and Department of Research, Landspitali haskolasjukrahus, Reykjavik, Iceland
  19. 19Department of Rheumatology and Inflammation Research, University of Gothenburg Faculty of Health Sciences, Goteborg, Sweden
  1. Correspondence to Dr Bente Glintborg, DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen University Hospital Glostrup, Glostrup, Denmark; glintborg{at}dadlnet.dk

Abstract

Background We aimed to describe the uptake of newer biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in psoriatic arthritis (PsA) in the Nordic countries and to compare their retention and effectiveness.

Methods Patients with PsA starting a b/tsDMARD in 2012–2020 in five Nordic rheumatology registers were included. Uptake and patient characteristics were described, with comorbidities identified from linkages to national patient registries. One-year retention and 6-month effectiveness (proportions achieving low disease activity (LDA) on the Disease Activity Index for PSoriatic Arthritis based on 28-joint evaluation) for the newer b/tsDMARDs (abatacept/apremilast/ixekizumab/secukinumab/tofacitinib/ustekinumab) were compared with adalimumab through adjusted regression models stratified by treatment course (first, second/third, and fourth or more).

Results In total, 5659 treatment courses with adalimumab (56% biologic-naïve) and 4767 courses with a newer b/tsDMARD (21% biologic-naïve) were included. The uptake of newer b/tsDMARDs increased from 2014 and plateaued in 2018. Patient characteristics appeared similar across treatments at treatment start. Adalimumab was more often used as the first course and newer b/tsDMARDs more often in biologic-experienced patients. Used as a second/third b/tsDMARD, the retention rate and the proportion achieving LDA were significantly better for adalimumab (rate 65%, proportion 59%) compared with abatacept (45%, 37%), apremilast (43%, 35%), ixekizumab (LDA only, 40%) and ustekinumab (LDA only, 40%), but not significantly different from other b/tsDMARDs.

Conclusion Uptake of newer b/tsDMARDs occurred mainly in biologic-experienced patients. Regardless of mode of action, only a minority of patients starting a second or later b/tsDMARD course remained on drug and achieved LDA. Superior outcomes for adalimumab indicate that the positioning of newer b/tsDMARDs in the PsA treatment algorithm remains to be established.

  • biological therapy
  • epidemiology
  • spondylitis, ankylosing
  • tumor necrosis factor inhibitors

Data availability statement

Due to privacy and ethical concerns any raw data can not be shared. Aggregated data can be shared upon reasonable request

http://dx.doi.org/10.1136/ard-2022-223650

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Due to privacy and ethical concerns any raw data can not be shared. Aggregated data can be shared upon reasonable request

    View Full Text

    Footnotes

    • Handling editor Josef S Smolen

    • BGI and DDG contributed equally.

    • Contributors Substantial contributions to study conception and design: BGl, DDG, UL, JKW. Substantial contributions to acquisition of data: all authors. Substantial contributions to analysis and interpretation of data: DDG, UL, BGl, JKW. Drafting the article or revising it critically for important intellectual content: all authors. Final approval of the version of the article to be published: all authors. Guarantor of the overall content: BGl

    • Funding The study is partly funded by NordForsk and Foreum grants. It is also partly funded by Vinnova, Swedish Research Council, Swedish Heart Lung Foundation and Karolinska Institutet/Region Stockholm (ALF). The Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) is funded as a Centre for Clinical Treatment Research by the Research Council of Norway (project 328657).

    • Competing interests BG: Pfizer, BMS, Sandoz and chairs the steering committee of the Danish Rheumatology Registry (DANBIO), which receives public funding from hospital owners and funding from pharmaceutical companies. JKW: AbbVie, Amgen, Eli Lilly, Novartis and Pfizer. DCN: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB. MLH: AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics BV, Lundbeckfonden, MSD, Pfizer, Roche, Samsung Bioepis, Sandoz and Novartis. JA: AbbVie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis and Sanofi. Agreements between Karolinska Institutet (with JA as PI) and the listed entities, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS). TS: AbbVie, BMS, Celgene, Medac, Merck, Novartis, Orion Pharma, Pfizer, Roche, Sandoz, UCB and Boehringer Ingelheim. SAP: Boehringer Ingelheim. BM: Novartis. EKK: Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) funded as a Centre for Clinical Treatment Research by the Research Council of Norway (project 328657). LD: BMS, Janssen, UCB and Boehringer Ingelheim.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.