Persistence of low disease activity after tumour necrosis factor inhibitor (TNFi) discontinuation in patients with psoriatic arthritis

Abstract

ObjectiveTo determine the duration of clinical benefit among patients with psoriatic arthritis (PsA) discontinuing tumour necrosis factor inhibitor (TNFi) therapy while in low disease activity (LDA), and to identify patient characteristics associated with prolonged clinical benefit.MethodsWe performed an observational cohort study assessing patients with PsA from the Consortium of Rheumatology Researchers of North America (CORRONA) registry who had discontinued TNFi after achieving LDA, defined as clinical disease activity index (CDAI) score ≤10 and physician's global assessment (PGA) of skin psoriasis ≤20/100. Kaplan–Meier method was used to estimate the duration of clinical benefit.ResultsOf the 5945 patients with PsA in CORRONA, 302 patients had discontinued TNFi (n=325) while in LDA and had follow-up data available. At time of discontinuation, mean PsA duration was 9.8 years, mean CDAI was 3.9, and mean duration of TNFi use was 1.5 years; 52.6% of patients had discontinued their first TNFi. Median time to loss of benefit was 29.2 months. 179 (55.1%) patients had persistent benefit at their previous clinic visit. An increased risk of losing clinical benefit was seen among patients with higher disease activity at discontinuation (CDAI≥3.2 vs <3.2; HR 1.43 (p=0.32)) and among smokers (HR 1.78 (p=0.027)).ConclusionsPatients with PsA who achieve LDA may maintain clinical benefit after discontinuation of TNFi therapy.

Dosing down with biologic therapies: a systematic review and clinicians’ perspective

“…In this case, the patients had their TNF inhibitors discontinued. In the cross-indication study, which included PsA patients, specific details were not clear for this population [ 45 ].…”

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

“…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.…”

The duration of remission and minimal disease activity after initiation and discontinuation of biological agents in patients with early psoriatic arthritis (data from the all-russian psoriatic arthritis registry)

“…В регистре CORRONA, насчитывающим 5945 больных ПсА, 352 пациента с низкой активностью болезни прекратили лечение иФНОα, данные были доступны по 302 пациентам [10]. Более чем у половины больных, отменивших иФНОα, сохранялась ремиссия и ее продолжительность составляла в среднем 29,2 мес.…”

“…Huynh и соавт. [10] считают важными факторами низкую активность болезни в момент отмены иФНОα и отсутствие курения.…”