Minimal Disease Activity and Anti–Tumor Necrosis Factor Therapy in Psoriatic Arthritis

Abstract

Objective. A state of minimal disease activity (MDA) was defined and validated as target for treatment in psoriatic arthritis (PsA). We aimed to identify disease characteristics, outcome, and predictors of MDA in patients treated with tumor necrosis factor a (TNFa) blockers. Methods. Patients fulfilling the Classification of Psoriatic Arthritis criteria treated with TNFa blockers were followed every 3-6 months. Patients were considered in MDA when they meet at least 5 of the 7 criteria. Sustained MDA was defined as an MDA state lasting ‡12 months. Patients achieving MDA were compared to non-MDA patients. A proportional odds discrete time survival analysis model was applied, adjusting for sex, age, PsA duration, abnormal erythrocyte sedimentation rate (ESR) and clinically damaged joint count at each visit to identify predictors for MDA. Results. Of the 306 patients treated with TNFa blockers identified from our database, 23 patients were in an MDA state when treatment was commenced; 57 were taking TNFa blockers prior to enrollment. Therefore, 226 subjects were in a non-MDA state and constituted the study population. One hundred forty-five patients of 226 patients (64%) achieved MDA within a mean 6 SD duration of 1.30 6 1.68 years. The mean 6 SD duration of MDA was 3.46 6 2.25 years. At total of 17 patients withdrew from therapy and remained in an MDA state. Male sex (odds ratio [OR] 1.65, 95% confidence interval [95% CI] 1.08-2.53; P 5 0.02) and normal ESR (OR 2.27, 95% CI 1.22-4.17; P 5 0.009) increased the odds for achieving MDA. Conclusion. MDA is achieved in 64% of patients treated with TNFa blockers in a clinical setting. Male sex and normal ESR are predictors for MDA. On withdrawal or reduction in treatment, 11.6% of patients maintained MDA state.

Sex differences in the efficacy, safety and persistence of patients with psoriatic arthritis treated with tofacitinib: a post-hoc analysis of phase 3 trials and long-term extension

“…While females more commonly met psoriasis criteria, fewer met the other MDA cut-off points. These findings are consistent with those from previous studies showing that females with PsA are less likely to achieve MDA irrespective of therapy 11 18 29–33. Worse scores at baseline likely explain the lower percentage of females achieving MDA states despite the similar efficacy of tofacitinib in males and females.…”

Minimal disease activity and associated factors in patients with psoriatic arthritis: cross-sectional study from a single center

“…Higher patient age and longer duration of PsA and PsO were found to be associated with higher MDA frequency in our study. Although male sex was associated with a higher MDA rate in previous studies [ 26 , 27 , 29 ], it did not differ in our study. On the other hand, higher TNFi retention was observed in males compared to females, in line with previous results [ 30 , 31 ].…”

Evidence for Psoriatic Arthritis Impact of Disease (PsAID12) as Core Instrument to Measure Health-Related Quality of Life in Psoriatic Arthritis: A Systematic Review of Psychometric Properties

“…30 Men were shown to achieve higher responses to treatment versus women. [30][31][32] In a recent study, PsAID12 scores were significantly higher for women versus men, 20 a finding similar across other PROMs including BASDAI, FACIT-Fatigue, PsAQoL, work impairment, PGA, HAQ-DI, EQ5D VAS, and presenteeism, but not DLQI. Based on these observations, it is expected that PsAID12 absolute scores will be higher in women than men.…”