Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry

Harrold, Leslie R.; Stolshek, Bradley S.; Rebello, Sabrina; Mutebi, Alex; Wade, Sally; Malley, Wendi; Greenberg, Jeffrey D.; Etzel, Carol J.

doi:10.1007/s10067-017-3593-x

Cited by 39 publications

(50 citation statements)

References 25 publications

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“…As expected, patients who failed prior biologic therapy were less likely to remain persistent on newer biologic agents, in keeping with the report of Harrold et al on data from the Corrona Registry on 549 biologic-naïve and 692 biologic-experienced PsA patients showing a greater mean time to non-persistence in the former group (16).…”

Section: Discussionsupporting

confidence: 86%

Treatment Persistence of Biologics among patients with Psoriatic Arthritis

Haddad

Gazitt

Feldhamer

et al. 2020

Preprint

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Background Persistence of biologic therapy in psoriatic arthritis (PsA) patients is an important factor in individualized patient treatment planning and healthcare policy and guideline development. . Objective To estimate the persistence of biologic agents prescribed to PsA patients in a real-life setting as well as factors associated with improved biologic drug survival in these patients. Methods Patients with PsA from a large health care provider database with at least two consecutive dispensed prescriptions of a biologic agent indicated for PsA from January 1st, 2002 until December 31st, 2018 were identified and followed until medication stop date or the end of observation period. Patients were considered non-persistent whenever a permissible lag time of 6 months from the time of prescription issuance until medication filling date was exceeded. Treatment changes were based on physician decisions and patient preferences. Demographic data including age, sex, body mass index (BMI), ethnicity, smoking history and socioeconomic status as well as Charlson comorbidity index were retrieved. Data regarding use of steroids and conventional disease-modifying anti-rheumatic drugs (cDMARDs) were also extracted. Descriptive statistics, including means (standard deviations) for continuous variables and frequencies (%) for categorical variables, were used. Persistence estimates were derived using non-parametric survival analysis using Kaplan-Meier functions, with treatment discontinuations as failure events. Cox regression hazard ratio models were conducted to investigate factors associated with drug persistence.Results 2301 PsA patients with 2958 treatment periods were identified and included in the analyses. Mean age of the study population was 50.9±14 years, 54% females, 70.4% with BMI>25, 40% current smokers, and 76% with a Charlson comorbidity index>1. The most commonly prescribed drug was etanercept (33%), followed by adalimumab (29%), golimumab (12%), secukinumab (10%), ustekinumab (8%) and infliximab (8%). While approximately 40% of patients persisted on therapy following 20 months of treatment, only about 20% of patients remained on any particular biologic agent after 5 years. Analyzing the data for all treatment periods while taking into account all lines of therapy, revealed that secukinumab had a higher persistency than adalimumab, infliximab and ustekinumab, with a Log Rank of 0.022, 0.047 and 0.001, respectively. Female sex and smoking were associated with lower drug persistence (HR=1.25, 95%CI=1.13-1.38 and HR=1.109, 95%CI=1.01-1.21, respectively). On analyzing the data using only the first indicated biologic line, no superiority of any single anti-Tumor Necrosis Factor-alpha (anti-TNFα) agent was observed. While, secukinumab was found to be superior as second line therapy to adalimumab, etanercept, infliximab and ustekinumab but not to golimumab with a Log-Rank P-value of 0.001, 0.004, 0.025 and 0.002, respectively. Conclusions In this large observational cohort studied in the era of biologic therapy, a relatively low drug persistence was observed, with female sex and smoking having a negative impact on persistency. None of the anti-TNFα agents was found to be more persistent than others as first line therapy, while secukinumab was found to be superior to other biologics when indicated as second line of therapy.

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Section: Discussionsupporting

confidence: 86%

Treatment Persistence of Biologics among patients with Psoriatic Arthritis

Haddad

Gazitt

Feldhamer

et al. 2020

Preprint

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“…Confounding by indication was possible; disease severity was generally mild in all cohorts and was within the same range across existing and initiated therapy, but some differences were seen for prior csDMARD use. Previous registry studies provided similar results but were conducted either outside the United States [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] or they used a subset of PsA patients from a registry in the United States that was designed primarily for patients with rheumatoid arthritis [40][41][42][43]. Our study used data from a registry in the United States that was specifically designed to collect information about patients with PsA.…”

Section: Discussionmentioning

confidence: 94%

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

Mease

Accortt

Rebello³

et al. 2019

Rheumatol Int

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This study described treatment patterns in a psoriatic arthritis (PsA) patient registry for new or ongoing tumor necrosis factor inhibitor (TNFi) monotherapy, conventional synthetic disease-modifying antirheumatic drug (csDMARD) monotherapy, or TNFi/csDMARD combination therapy. This retrospective analysis included adults with PsA who enrolled in the Corrona PsA/ spondyloarthritis registry between March 21, 2013 (registry initiation), and January 31, 2017, and received an approved TNFi and/or csDMARD as "existing use" starting before registry entry or "initiated use" starting on/after registry entry. Therapy persistence was defined as index therapy use for ≥ 12 months without a treatment gap of ≥ 30 days. Among the evaluable patients with existing TNFi monotherapy (n = 251), csDMARD monotherapy (n = 225), and combination therapy (n = 214), 93, 87, and 87% were persistent for ≥ 12 months, and another 6, 5, and 5%, respectively, had no change with < 12 months of follow-up after first use. Among evaluable patients who initiated use of TNFi monotherapy (n = 26), csDMARD monotherapy (n = 35), and combination therapy (n = 15), 50, 43, and 53% were persistent for ≥ 12 months, and another 27, 20, and 20%, respectively, had no change with < 12 months of follow-up after first use. After initiation of index therapy, most changes (19-27% of patients) were discontinuation; 4-13% switched biologic therapy during follow-up. The results of this analysis of real-world treatment patterns in a PsA patient registry suggest that nonpersistence for TNFi monotherapy, csDMARD monotherapy, or TNFi/csDMARD combination therapy occurs more commonly after initiation of therapy than in patients with existing therapy. Trial registration: NCT02530268.

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“…A prior study of patients with PsA enrolled in the Corrona Registry showed that a higher proportion of biologic-naive patients were persistent on their TNFi over 4 years of follow-up compared with biologic-experienced patients and that biologic-naive patients had a longer time to non-persistence compared with biologic-experienced patients (median, 32 vs 23 months) 28. Consistent with the results of the prior study, TNFi-naive patients in our study had a longer time to discontinuation (median, 27 vs 20 months) and were less likely to discontinue or switch biologics compared with TNFi-experienced patients.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have characterised patients with PsA who continue versus discontinue a TNFi based on line of TNFi therapy in real-world settings in the USA. A previous study of patients with PsA enrolled in the US-based Corrona Registry observed greater persistence with TNFi therapy among biologic-naive patients compared with biologic-experienced patients; baseline patient characteristics associated with non-persistence included high disease activity and longer disease duration in both patient populations as well as prior non-biologic disease-modifying antirheumatic drug use and greater skin involvement among biologic-experienced patients 28. However, this study was conducted in patients enrolled in the Corrona Registry who initiated a TNFi between October 2002 and March 2013, prior to the approval of biologics with alternative mechanisms of action (MOAs) for the treatment of PsA and before the launch of the Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry (March 2013), which focuses on a unique cohort of patients with PsA/SpA.…”

Section: Introductionmentioning

confidence: 86%

Discontinuation and switching patterns of tumour necrosis factor inhibitors (TNFis) in TNFi-naive and TNFi-experienced patients with psoriatic arthritis: an observational study from the US-based Corrona registry

et al. 2019

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ObjectiveTo examine patterns of tumour necrosis factor inhibitor (TNFi) use in TNFi-naive and TNFi-experienced patients with psoriatic arthritis (PsA) in the USA.MethodsAll patients aged ≥18 years with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry who initiated a TNFi (index therapy) between March 2013 and January 2017 and had ≥1 follow-up visit were included. Times to and rates of discontinuation/switch of the index TNFi were compared between TNFi-naive and TNFi-experienced cohorts. Patient demographics and disease characteristics at the time of TNFi initiation (baseline) were compared between cohorts and between patients who continued versus discontinued their index TNFi by the first follow-up visit within each cohort.ResultsThis study included 171 TNFi-naive and 147 TNFi-experienced patients (total follow-up, 579.2 person-years). Overall, 75 of 171 TNFi-naive (43.9%) and 80 of 147 TNFi-experienced (54.4%) patients discontinued their index TNFi; 33 of 171 (19.3%) and 48 of 147 (32.7%), respectively, switched to a new biologic. TNFi-experienced patients had a shorter time to discontinuation (median, 20 vs 27 months) and were more likely to discontinue (p=0.03) or switch (p<0.01) compared with TNFi-naive patients. Among those who discontinued, 49 of 75 TNFi-naive (65.3%) and 59 of 80 TNFi-experienced (73.8%) patients discontinued by the first follow-up visit; such patients showed a trend towards higher baseline disease activity compared with those who continued.ConclusionsThe results of this real-world study can help inform treatment decisions when selecting later lines of therapy for patients with PsA.

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Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry

Cited by 39 publications

References 25 publications

Treatment Persistence of Biologics among patients with Psoriatic Arthritis

Treatment Persistence of Biologics among patients with Psoriatic Arthritis

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

Discontinuation and switching patterns of tumour necrosis factor inhibitors (TNFis) in TNFi-naive and TNFi-experienced patients with psoriatic arthritis: an observational study from the US-based Corrona registry

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