Effectiveness and treatment retention of TNF inhibitors when used as monotherapy versus comedication with csDMARDs in 15 332 patients with psoriatic arthritis. Data from the EuroSpA collaboration

Lindström, Ulf; Giuseppe, Daniela Di; Delcoigne, Bénédicte; Glintborg, Bente; Möller, Burkhard; Ciurea, Adrian; Pombo‐Suárez, Manuel; Sánchez-Piedra, Carlos; Eklund, Kari K.; Relas, Heikki; Guðbjörnsson, Björn; Löve, Thorvarður Jón; Jones, Gareth T; Codreanu, Cătălin; Ionescu, Ruxandra; Nekvindová, Lucie; Závada, Jakub; Ataş, Nuh; Yolbaş, Servet; Fagerli, K.; Michelsen, Brigitte; Rotar, Žiga; Tomšič, Matija; Iannone, Florenzo; Santos, María José; Ávila-Ribeiro, Pedro; Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jacobsson, Lennart; Askling, Johan; Nissén, Michael John

doi:10.1136/annrheumdis-2021-220097

Cited by 34 publications

(22 citation statements)

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“…Although persistence rates reported in the literature vary widely depending on the study and definition used, we found 1-year rates for biologics similar to those reported previously. Specifically, the previous 1-year rates of TNF inhibitor persistence ranged from 65% to 79% for PsO and from 56% to 90% for PsA . The corresponding values in the present study were 73.8% and 72.3%, respectively.…”

Section: Discussionsupporting

confidence: 45%

Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database

et al. 2022

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IMPORTANCETreatment options for psoriasis (PsO) and psoriatic arthritis (PsA) have evolved significantly throughout the era of biologics. Clinical trials are inadequate to assess the relative long-term efficacy of biologics and are often insufficient regarding safety.OBJECTIVES To assess the long-term persistence of different biologic classes to treat PsO and PsA. DESIGN, SETTING, AND PARTICIPANTSThis nationwide cohort study involved the administrative health care database of the French health insurance scheme linked to the hospital discharge database. All adults with PsO and PsA who were new users of biologics (not in the year before the index date) from January 1, 2015, to May 31, 2019, were included and followed up through December 31, 2019. Patients hospitalized for PsA in the PsO cohort and for PsO in the PsA cohort in the year before the index date were excluded. Data were analyzed from June 1 to October 31, 2021.MAIN OUTCOMES AND MEASURES Persistence was defined as the time from biologic therapy initiation to discontinuation and was estimated using the Kaplan-Meier method. Comparison of persistence by biologic class involved using propensity score-weighted Cox proportional hazards regression models and adjustment on specific systemic nonbiologics (time-dependent variables).RESULTS A total of 16 892 patients with PsO were included in the analysis (mean [SD] age, 48.5 [13.8] years; 9152 men [54.2%] men). Of these, 10 199 patients (60.4%) started therapy with a tumor necrosis factor (TNF) inhibitor; 3982 (23.6%), with an interleukin 12 and interleukin 23 (IL-12/23) inhibitor; and 2711 (16.0%), with an interleukin 17 (IL-17) inhibitor. An additional 6531 patients with PsA (mean [SD] age, 49.1 [12.8] years; 3565 [54.6%] women) were included; of these, 4974 (76.2%) started therapy with a TNF inhibitor; 803 (12.3%), with an IL-12/23 inhibitor; and 754 (11.5%), with an IL-17 inhibitor. Overall 3-year persistence rates were 40.9% and 36.2% for PsO and PsA, respectively. After inverse probability of treatment weighting and adjustment, the IL-17 inhibitor was associated with higher persistence compared with the TNF inhibitor for PsO (weighted hazard ratio [HR], 0.78 [95% CI, 0.73-0.83]) and PsA (weighted HR, 0.70 [95% CI, 0.58-0.85]) and compared with the IL-12/23 inhibitor for PsA (weighted HR, 0.69 [95% CI,). No difference between the IL-17 inhibitor and IL-12/23 inhibitor for PsO was noted. The IL-12/23 inhibitor was associated with higher persistence than the TNF inhibitor for PsO (weighted HR, 0.76 [95% CI, 0.72-0.80]), with no difference observed for PsA. CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that IL-17 inhibitors are associated with higher treatment persistence than the TNF inhibitor for PsO and PsA. Interleukin 17 inhibitors were also associated with higher persistence than the IL-12/23 inhibitor for PsA, with no difference for PsO. However, the persistence rates of all biologics remained globally low at 3 years.

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Section: Discussionsupporting

confidence: 45%

Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database

et al. 2022

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“…A striking fact of our study was the predictive capacity of previous exposure to methotrexate in terms of lower persistence of IXE. These data are especially curious if we consider that the concomitant use of methotrexate tends to prolong the survival of TNFi in PsA [ 16 ]. The hypothesis put forward in these studies is that methotrexate would reduce the immunogenicity against TNFi, allowing a higher survival of these drugs [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…These data are especially curious if we consider that the concomitant use of methotrexate tends to prolong the survival of TNFi in PsA [ 16 ]. The hypothesis put forward in these studies is that methotrexate would reduce the immunogenicity against TNFi, allowing a higher survival of these drugs [ 16 ]. However, clinical trials with IXE show that the associated use of methotrexate has no role in either the therapeutic response or the persistence of the drug [ 5 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment Retention and Safety of Ixekizumab in Psoriatic Arthritis: A Real Life Single-Center Experience

Braña

Pardo

Burger

et al. 2023

JCM

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Background and objectives: Information on the performance of ixekizumab (IXE) in patients with psoriatic arthritis (PsA) in clinical practice is scarce. We aimed to analyze the retention rate and safety of IXE in patients with PsA in routine clinical practice. Methods: A retrospective longitudinal observational single-center study of all patients with PsA who had received at least one dose of IXE. Adverse events (AEs) and drug retention rate were the main study focus. Survival was analyzed using Kaplan–Meier curves and predictive factors using multivariate Cox regression analysis. The hazard ratio (HR) was used as a measure of the association. Results: Seventy-two patients were included (52 women and 20 men). Median disease duration was 5 years (IQR 3–9). More than 90% received ≥2 biologic and/or targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) prior to IXE. Ixekizumab showed a 1-year retention rate of 65% and a 2-year retention rate of 57%. Regarding discontinuation due to AEs, 0.18 AEs per person-year were identified. The number of previous biologics did not influence drug survival but prior use of methotrexate (HR 2.31 (95% CI 1.05–5.10), p < 0.05) and depression (HR 2.40 (95% CI 1.07–5.41), p < 0.05) increased the risk of IXE discontinuation. Conclusions: Ixekizumab showed a good retention rate in a PsA population mostly refractory to biologic and targeted synthetic DMARDs. Drug survival was consistently good regardless of age, gender, metabolic comorbidities, smoking status, or prior number of biologic therapies. This information may be of interest to better position this drug in the PsA treatment algorithms.

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“…В то же время в наблюдательном исследовании U. Lindström и соавт. [13] на большой выборке пациентов с ПсА (более 15 332 человек) показано, что терапия иФНО-α АДА и инфликсимабом в комбинации с МТ на 50% повышает вероятность достижения ремиссии по DAS28 в течение 1 года лечения по сравнению с монотерапией иФНО-α.…”

Section: Discussionunclassified

2-years outcomes of the treat-to-target strategy in early psoriatic arthritis

Loginova¹,

Коротаева²,

Gubar³

et al. 2022

Naučno-praktičeskaâ revmatologiâ

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Aim – to study 2 years outcomes of the treat-to-target (T2T) strategy in early psoriatic arthritis (ePsA) patients. Material and methods. 68 (33 male/35 female) ePsA patients according to CASPAR criteria (mean age – 37.3±10.8 years; PsA duration – 11.0±9.8 months) were included and were observed till 2 years follow-up. At baseline and every 3 months all patients underwent standard clinical examinations. All patients was given mono-therapy with Methotrexate (MTX) s/c or in combination with biological (b) DMARDs. The number of pts achieved remission (DAPSA≤4), low disease activity (LDA) (5≥DAPSA≤14), minimal disease activity (MDA) (5/7) or very low disease activity (VLDA) (7/7) at least 1 time were calculated. Analysis were performed into three groups depends on type of therapy: 1st group (19 patients) – MTX-monotherapy; 2nd group (11 patients) – combination MTX with bDMARDs; 3rd group – 25 patients who stopped taken bDMARD by the end of the follow-up. Results. By 2 years of follow-up remission by DAPSA/LDA/MDA/VLDA was seen in 51.5%/16.2%/58.8%/42.65% of patients accordingly. In the 1st/2nd groups remission by DAPSA was noted in 68.4%/90% and MDA – in 81.8%/78.9% of patients accordingly. In the 3rd group remission by DAPSA/MDA maintained in 24%/32% of patients accordingly. Conclusion. The T2T strategy is optimal management approach in more than half of the ePsA patients despite of type of treatment within 2 years . The stopped of bDMARD caused a “lost” of remission/MDA in the most of patients.

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Effectiveness and treatment retention of TNF inhibitors when used as monotherapy versus comedication with csDMARDs in 15 332 patients with psoriatic arthritis. Data from the EuroSpA collaboration

Cited by 34 publications

References 22 publications

Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database

Long-term Persistence of First-line Biologics for Patients With Psoriasis and Psoriatic Arthritis in the French Health Insurance Database

Treatment Retention and Safety of Ixekizumab in Psoriatic Arthritis: A Real Life Single-Center Experience

2-years outcomes of the treat-to-target strategy in early psoriatic arthritis

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