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

Abstract

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.

Clinical Characteristics, Disease Activity, Functional Status, and Quality of Life Results of Patients With Psoriatic Arthritis Using Biological and Conventional Synthetic Disease-Modifying Antirheumatic Drugs

“…[ 13 , 24 ] In the literature, a study using DAPSA and clinical DAPSA for evaluating disease activity determined that while the disease activity was moderate among patients undergoing csDMARD monotherapy and combination, the average disease activity was in the “remission” stage among those undergoing a combination csDMARD and bDMARD therapy or a bDMARD monotherapy. [ 25 , 26 ] In agreement with these findings, our study determined that the average disease activity among patients not using any medication and those undergoing csDMARD monotherapy was higher compared with that of patients undergoing combination csDMARD and bDMARD therapy or a bDMARD monotherapy. Similarly, according to the DAS28 criteria, it was observed that most patients were kept under control superiorly with bDMARD monotherapy or any combination with csDMARD.…”

Long‐Term Efficacy and Safety of Guselkumab, a Monoclonal Antibody Specific to the p19 Subunit of Interleukin‐23, Through Two Years: Results From a Phase III, Randomized, Double‐Blind, Placebo‐Controlled Study Conducted in Biologic‐Naive Patients With Active Psoriatic Arthritis

“…In addition, it is not uncommon for PsA patients to switch biologic treatments due to loss of efficacy over time or intolerance (3,4). Recent findings from an observational study of biologics in PsA patients show that treatment persistence and achieving low disease activity at 1 year was predictive of longer-term persistence and remission at 12 years (5), highlighting the current unmet need for treatments exhibiting durable efficacy and safety (6,7). The Th17 cell line has been identified as a critical driver of skin inflammation in psoriasis (8,9) and may also drive articular disease pathogenesis, given that interleukin-17A (IL-17A) inhibitors have demonstrated therapeutic benefits in this compartment (10).…”

“…In addition, it is not uncommon for PsA patients to switch biologic treatments due to loss of efficacy over time or intolerance ( 3 , 4 ). Recent findings from an observational study of biologics in PsA patients show that treatment persistence and achieving low disease activity at 1 year was predictive of longer‐term persistence and remission at 12 years ( 5 ), highlighting the current unmet need for treatments exhibiting durable efficacy and safety ( 6 , 7 ).…”

Efficacy and Safety of Guselkumab, an Interleukin‐23p19–Specific Monoclonal Antibody, Through One Year in Biologic‐Naive Patients With Psoriatic Arthritis

“…In the Corrona registry, ~30% of tumor necrosis factor inhibitors (TNFi) started by PsA patients were discontinued within 1 year, and biologic‐exposed patients demonstrated lower TNFi drug persistence than biologic‐naive patients ( 4 ). The high proportion (80%) of these patients discontinuing the index TNFi because of inadequate efficacy ( 5 ) highlights the need to consider other modes of action to treat these PsA patients. Guselkumab (Janssen Biotech), a fully human monoclonal antibody specific to the p19 subunit of interleukin‐23 (IL‐23), was approved to treat adults with moderate‐to‐severe plaque psoriasis in 2017.…”